Biomaterial Database

The policy context of patient centered medical homes: perspectives of primary care providers. 2013

Jeffrey A Alexander, and Genna R Cohen, and Christopher G Wise, and Lee A Green

Department of Health Management and Policy, The University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. jalexand@umich.edu

BACKGROUND Interest in the patient centered medical home (PCMH) model has increased significantly in recent years. Despite this attention, information is limited regarding the influence of policy context on implementation of the PCMH model. Using comparative, qualitative data, we identify several key policy impediments to PCMH implementation, and propose practical guidelines for addressing these issues. METHODS Qualitative, semi-structured in-person interviews with representatives of physician organizations and primary care practices pursuing PCMH. METHODS Practitioners and staff at 16 physician practices in Michigan, as well as key leaders of physician organizations. RESULTS We identified five primary policy issues cited by physicians and physician organization leaders as most impactful on their efforts to adopt PCMH: misalignment of current reimbursement schemes, administrative burden, conflicting criteria for PCMH designation, workforce policy issues, and uncertainty of health care reform. These policies were largely seen as barriers to their ability to implement PCMH. CONCLUSIONS Providers' motivation to embrace PCMH, and their level of confidence regarding the results of such change, are greatly influenced by their perception of the external environment and the control they believe they have over this environment. Having policies in place that shape the path to PCMH in a manner that makes it as easy as possible for providers to accomplish the desired changes could well make the difference in whether successful transformation is achieved.

UI	MeSH Term	Description	Entries
D008824	Michigan	State bounded on the north by the Great Lakes, on the east by Canada, on the south by Wisconsin, Indiana, and Ohio, and on the west by Lake Michigan and Wisconsin.
D011320	Primary Health Care	Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)	Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D012051	Reimbursement Mechanisms	Processes or methods of reimbursement for services rendered or equipment.	Mechanism, Reimbursement,Mechanisms, Reimbursement,Reimbursement Mechanism
D006284	Health Plan Implementation	Those actions designed to carry out recommendations pertaining to health plans or programs.	Health Plan Implementations,Implementation, Health Plan,Implementations, Health Plan,Plan Implementation, Health,Plan Implementations, Health
D006302	Health Services Research	The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)	Health Care Research,Medical Care Research,Research, Health Services,Action Research,Health Services Evaluation,Healthcare Research,Research, Medical Care,Evaluation, Health Services,Evaluations, Health Services,Health Services Evaluations,Research, Action,Research, Health Care,Research, Healthcare
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000078329	Workforce	The number of people working or available for work or service.	Human Resources,Labor Supply,Manpower,Staffing,Womanpower,Human Resource,Labor Supplies,Manpowers,Staffings,Supply, Labor,Womanpowers,Workforces
D001291	Attitude of Health Personnel	Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.	Staff Attitude,Attitude, Staff,Attitudes, Staff,Health Personnel Attitude,Health Personnel Attitudes,Staff Attitudes
D016134	Organizational Policy	A course or method of action selected, usually by an organization, institution, university, society, etc., from among alternatives to guide and determine present and future decisions and positions on matters of public interest or social concern. It does not include internal policy relating to organization and administration within the corporate body, for which ORGANIZATION AND ADMINISTRATION is available.	Institutional Policy,Institutional Policies,Organizational Policies,Policies, Institutional,Policies, Organizational,Policy, Institutional,Policy, Organizational
D016526	Workload	The total amount of work to be performed by an individual, a department, or other group of workers in a period of time.	Employee Workload,Staff Workload,Employee Work Load,Staff Work Load,Work Load,Employee Work Loads,Employee Workloads,Staff Work Loads,Staff Workloads,Work Load, Employee,Work Load, Staff,Work Loads,Work Loads, Employee,Work Loads, Staff,Workload, Employee,Workload, Staff,Workloads,Workloads, Employee,Workloads, Staff