The American Academy of Family Physicians National Demonstration Project on the patient-centered medical home (PCMH) concluded almost a year ago, and as the project comes under evaluation experts have raised concerns and recommendations.
The project included more than 36 practices across the nation and assessed the usefulness and impact on quality of care and business performance of the PCMH model. It divided the practices into facilitated and self-directed groups. In the facilitated group practices received support from TransforMED, a redesign initiative of the AAFP, in the form of tailored implementation strategies, organized change management, integrated software technology and team training. In the self-directed group practices received minimal intervention with access to practice improvement tools and services via information provided on the Web site.
The project included practices that ranged in size (from solo to 10-15 physicians), urban/rural, and ownership (physician-owned, hospital owned, etc.).
“None of these characteristics seemed to preclude practice ability to implement model components. It is not true, for example, that small, rural practices are unable to do this, “ said Paul Nutting, MD, one of the authors of a paper analyzing the project’s “lessons learned” and director of research at the Center for Research Strategies LLC.
One particular concern was that the project “overestimated the readiness and expectations of information technology,” with new technology implementation “more difficult and time consuming than originally envisioned.”
Nutting said the paper wanted to alert people to the fact that making these changes to your practice can take longer than you think. “And it’s not just implementing the technology but using it once it is in place,” he says.
“The study showed that it’s not just about implementing a bunch of components,” agreed Melissa Gerdes, MD, medical director of Trinity Clinic Whitehouse in Texas, which was part of the facilitated group. “It’s really about being responsive to needing to add those things and how to implement them without undermining workflow.” Technology is one of the humps that practices will need to get over as they begin to transform their practices, says Nutting. He says when he talks to practices about the changes they are making they say it is “more of a journey than a destination.”
“A transformation is a change in mental model, practice will always be trying to get better,” he said.
“It’s never going to end,” says Kim Leatham, MD, of Virginia Mason Winslow Clinic, a large physician practice in Bainbridge Island, Wash., which was in self-directed group. “There’s always going to be a transformation and ongoing change for improvement. In two years we made a huge number of changes but it also makes you realize how much more you have to do.”
