The proposed demonstration and dissemination project uses mixed methods to investigate how safety-net primary care practices in the Greater New Orleans Area (NOLA) have transformed their operations to become recognized by the National Committee for Quality Assurance (NCQA) as patient-centered medical homes (PCMHs). The PCMH model holds much promise for primary care redesign and health reform. It shifts the focus of reform towards efficient health care delivery via enhanced primary care. It guides providers to develop care that is patient-centered, coordinated, accessible, and of high quality, while pointing systems towards physician payment reforms that support enhanced primary care. Little is currently known, however, about the impact of PCMH-guided practice transformation on patient outcomes, patient and provider experience, and costs. Nor do we know much about how primary care practices successfully overcome barriers to implementing the PCMH model. In theory, the PCMH holds special promise for improving safety-net care in places like New Orleans. It could increase efficiency in these cash-strapped practices, improve continuity of care for populations with a high burden of chronic illness, and enhance patient trust, access and health literacy. However, currently, there is virtually no evidence-based guidance available on how the PCMH model can be fruitfully adapted to better meet the needs of underserved communities.
The specific aims of this project are: 1) To validate implementation of the PCMH model within each of five NCQA-recognized primary care practices over three years using quantitative data on process changes within each practice, and trends in patient outcome and costs;2) To better understand barriers to implementing the PCMH model, particularly in the healthcare safety net, and how successful practices overcome those barriers through qualitative case studies;and 3) To disseminate what we have learned from exemplary primary care practices in New Orleans about how to successfully adopt the PCMH model, and what changes can be expected for patients and providers as a result. We address these aims using a mixed-method approach. This consists of quantitative analyses of patient outcomes and cost data within each primary care practice;direct observation and key-informant interviews with practice leaders, staff, front-line providers and consumers;and a mixture of dissemination methods that target healthcare stakeholders in post-Katrina New Orleans, national provider and policymaker audiences, and health services and policy researchers. Project results will contribute to an evidence base that demonstrates how, and to what degree, PCMHs can be implemented in real-world primary care practices, with particular attention to the healthcare safety net.

Public Health Relevance

The patient-centered medical home (PCMH) is a widely discussed model of health care delivery system reform that promises to increase quality of patient care and decrease overall health system costs. Little research has been performed examining whether PCMH-based reforms actually lead to improvements in patient outcomes, patient and provider experience, and costs. Nor do we know much about how primary care providers successfully overcome barriers to implementing the PCMH model. The proposed demonstration and dissemination project will provide an in-depth examination of five exemplary PCMH safety-net practices and widely disseminate findings to aid providers, policymakers and researchers who seek guidance on successfully implementing the PCMH model.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZHS1-HSR-W (01))
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Meyers, David
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University of California San Francisco
Family Medicine
Schools of Medicine
San Francisco
United States
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Rittenhouse, Diane R; Schmidt, Laura; Wu, Kevin et al. (2013) Contrasting trajectories of change in primary care clinics: lessons from New Orleans safety net. Ann Fam Med 11 Suppl 1:S60-7