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Date: May 12, 2009
Contact: Jennifer Forbes
Communication & Public Affairs
Phone: 732-235-6356
Email: jenn.forbes@umdnj.edu
Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home
NEW BRUNSWICK, NJ; Transforming a primary care practice to a patient-centered medical home (PCMH) is possible, but is more difficult than is generally appreciated, according to the first report of the evaluation team of the National Demonstration Project (NDP). The report, “Initial Lessons from the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home,” is authored by the NDP evaluation team and appears in the May/June 2009 Annals of Family Medicine.
The American Academy of Family Physicians supported the two-year NDP, which worked with 36 practices across the country. Half received intensive assistance from change facilitators and half were given access to tools, but were asked to make changes largely on their own. The independent evaluation team gathered extensive qualitative and quantitative data from all 36 practices and will issue a series of reports on their findings. This initial report describes early insights into the challenges faced by the practices and those attempting to help them and provides valuable initial information for the many state and regional demonstrations that have emerged in recent years.
Paul A. Nutting, MD, MSPH, department of family medicine, University of Colorado Health Sciences Center, Denver, served as the senior author of the report. Benjamin F. Crabtree, PhD, professor and chief of the division of research in the department of family medicine at UMDNJ-Robert Wood Johnson Medical School, was a co-author and member of the evaluation team.
The authors describe six early lessons from the NDP. First, becoming a PCMH is not a simple incremental process but requires transformation and whole practice redesign. Second, the information technology currently available is seriously underdeveloped for small practices and very difficult to implement. Third, building a medical home requires personal transformation of physicians and their view of how they practice medicine. Fourth, “change fatigue” is a serious problem even within capable and highly motivated practices. Fifth, transformation to a PCMH is a developmental process that will take 3-5 years for most practices to achieve. Finally, the specific pathway to and eventual model of the PCMH is highly dependent on the local circumstances of each practice.
Based on the experience of the NDP, the evaluation team offers four recommendations for those assisting the transformation of primary care practices. First, the process requires time and financial resources that are not often readily available to the practice. Second, tailor the transformation approach for the individual practice and neither over-specify the final model nor the precise pathway for achieving it. Third, professional organizations should assist physicians with their personal transformation to a new way of doctoring. Finally, NCQA should modify its certification process to encourage and accommodate a multi-year developmental approach.
Finally, the authors offer advice to practices engaging in the transformation process. First, establish realistic expectations for time and resources required. Second, build a technology implementation plan that carefully considers which components to implement and in what sequence. Third, monitor change fatigue and burnout that can be damaging to the practice. Finally, adopt a ‘learning organization’ model for the practice, rather than relying on the conventional expert consultant model.
Media interested in interviewing Dr. Paul Nutting, may contact Jennifer Forbes at 732-235-6356.
To learn more about the National Demonstration Project, please visit http://www.transformed.com/ndp.cfm
