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Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon
Sherril Gelmon1, Nicole Bouranis2, Billie Sandberg2
1From Oregon Health and Sciences University-Portland State University School of Public Health, Portland OR (SG, NB, SP); Mark O. Hatfield School of Government, Portland State University, Portland (BS). gelmons@pdx.edu.
Summary
Exemplary patient-centered medical homes (PCMHs) in Oregon successfully implemented strategies to overcome common challenges. These PCMHs utilized team-based care, patient outreach, and integrated services to improve primary care delivery.
Area of Science:
- Primary Care Transformation
- Health Systems Reform
- Quality Improvement in Healthcare
Background:
- Patient-centered medical homes (PCMHs) are key to primary care reform.
- Existing literature details PCMH implementation challenges but lacks strategy insights.
- This study examines strategies used by exemplary PCMHs in Oregon.
Purpose of the Study:
- To identify and describe strategies employed by high-performing PCMHs to overcome implementation challenges.
- To provide practical insights for other healthcare organizations seeking to adopt the PCMH model.
Main Methods:
- Observation of 20 exemplary Patient-Centered Primary Care Homes (PCPCHs) in Oregon.
- Semistructured interviews and focus groups with 85 key informants between 2015 and 2016.
Main Results:
- Common challenges included care use patterns, model fidelity, and process refinement.
- Ten key implementation strategies emerged: expanded access via care teams, ED visit prevention, improved communication, metric prioritization, patient-centered practices, continuous improvement capacity, preventive/chronic care integration, workflow standardization, EHR customization, and mental health integration.
Conclusions:
- Clinic leaders' understanding of local context is beneficial.
- Successful clinics embraced "learning organization" principles.
- Clinics can leverage their characteristics, state resources, and peer experiences for PCMH implementation.
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