Practice transformation in teaching settings: lessons from the I³ PCMH collaborative

Area of Science:

• Health Services Research
• Medical Education
• Quality Improvement

Background:

• The Patient-centered Medical Home (PCMH) model guides practice transformation for enhanced quality, accessibility, and patient satisfaction.
• Primary care residencies can adopt PCMH principles, but effective facilitation strategies require further investigation.
• This study details the design, implementation, and initial outcomes of an academic PCMH collaborative.

Purpose of the Study:

• To describe the design, implementation, and initial outcomes of an academic PCMH collaborative.
• To assess the effectiveness of a collaborative model in facilitating practice transformation toward PCMH recognition.
• To identify key lessons learned from primary care residency programs engaged in PCMH transformation.

Main Methods:

• The I³ PCMH Collaborative utilized the Institute for Healthcare Improvement's Breakthrough Collaborative model.
• 25 primary care teaching sites across three states participated over a 20-month period.
• The National Committee for Quality Assurance (NCQA) PCMH Recognition Program defined goals and outcome measures, with surveys and activity assessments tracking progress.

Main Results:

• 48% of participating programs achieved NCQA PCMH recognition or submitted applications.
• 56% of programs described their PCMH improvements as "significant," and 12% as "sustainable."
• 64% credited the collaborative for maintaining focus on transformation, and 84% expressed interest in future collaboratives.

Conclusions:

• Heterogeneous primary care residency programs can achieve substantial, measurable PCMH improvements through collaboration.
• A modest investment in collaborative infrastructure can yield significant practice transformation.
• Collaborative models are effective in supporting practice improvement initiatives in academic primary care settings.