Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes
Identifieur interne : 000240 ( Main/Exploration ); précédent : 000239; suivant : 000241Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes
Auteurs : Melissa M. Farmer [États-Unis] ; Danielle E. Rose [États-Unis] ; Lisa V. Rubenstein [États-Unis] ; Ismelda A. Canelo [États-Unis] ; Gordon Schectman [États-Unis] ; Richard Stark [États-Unis] ; Elizabeth M. Yano [États-Unis]Source :
- Journal of General Internal Medicine [ 0884-8734 ] ; 2014.
Abstract
While the potential of patient-centered medical homes (PCMH) is promising, little is known empirically about the frontline challenges that primary care (PC) leaders face before making the decision to implement PCMH, let alone in making it a reality.
Prior to the design and implementation of the Veterans Health Administration’s (VA) national PCMH model—Patient Aligned Care Teams (PACT)—we identified the top challenges faced by PC directors and examined the organizational and area level factors that influenced those challenges.
A national cross-sectional key informant organizational survey was fielded to the census of PC directors at VA medical centers and large community-based outpatient clinics (final sample n = 229 sites).
PC directors were asked to rate the degree to which they faced 48 management challenges in eight PCMH-related domains (access, preventive care, chronic diseases requiring care in PC, challenging medical conditions, mental health/substance abuse, special populations, PC coordination of care, and clinical informatics). Responses were dichotomized as moderately-to-extremely challenging versus somewhat-slightly-not at all challenging. Items were rank ordered; chi square or regression techniques were used to examine variations in facility size, type, urban/rural location, and region.
On average, VA PC directors reported 16 moderate-to-extreme challenges, and the top 20 challenges spanned all eight PCMH domains. Four of the top 20 challenges, including the top two challenges, were from the clinical informatics domain. Management of chronic non-malignant pain requiring opiate therapy was the third most reported challenge nationwide. Significant organizational and area level variations in reported challenges were found especially for care coordination.
Better understanding of PC challenges ahead of PCMH implementation provides important context for strategic planning and redesign efforts. As a national healthcare system, the VA provides a unique opportunity to examine organizational and area determinants relevant to other PCMH models.
Url:
DOI: 10.1007/s11606-013-2691-y
PubMed: 24715394
PubMed Central: 4070226
Affiliations:
Links toward previous steps (curation, corpus...)
- to stream Pmc, to step Corpus: 000153
- to stream Pmc, to step Curation: 000153
- to stream Pmc, to step Checkpoint: 000227
- to stream Ncbi, to step Merge: 000515
- to stream Ncbi, to step Curation: 000515
- to stream Ncbi, to step Checkpoint: 000515
- to stream Main, to step Merge: 000240
- to stream Main, to step Curation: 000240
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes</title>
<author><name sortKey="Farmer, Melissa M" sort="Farmer, Melissa M" uniqKey="Farmer M" first="Melissa M." last="Farmer">Melissa M. Farmer</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Rose, Danielle E" sort="Rose, Danielle E" uniqKey="Rose D" first="Danielle E." last="Rose">Danielle E. Rose</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Rubenstein, Lisa V" sort="Rubenstein, Lisa V" uniqKey="Rubenstein L" first="Lisa V." last="Rubenstein">Lisa V. Rubenstein</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff2">Division of General Internal Medicine and Health Services Research, David Geffen UCLA School of Medicine, Los Angeles, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>Division of General Internal Medicine and Health Services Research, David Geffen UCLA School of Medicine, Los Angeles</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff3">RAND Health, Santa Monica, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>RAND Health, Santa Monica</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff4">Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, Sepulveda, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, Sepulveda</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Canelo, Ismelda A" sort="Canelo, Ismelda A" uniqKey="Canelo I" first="Ismelda A." last="Canelo">Ismelda A. Canelo</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Schectman, Gordon" sort="Schectman, Gordon" uniqKey="Schectman G" first="Gordon" last="Schectman">Gordon Schectman</name>
<affiliation wicri:level="2"><nlm:aff id="Aff5">Office of Patient Care Services, Veterans Health Administration, Washington, DC USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">District de Columbia</region>
</placeName>
<wicri:cityArea>Office of Patient Care Services, Veterans Health Administration, Washington</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Stark, Richard" sort="Stark, Richard" uniqKey="Stark R" first="Richard" last="Stark">Richard Stark</name>
<affiliation wicri:level="2"><nlm:aff id="Aff6">Office of Primary Care Clinic Operations, Veterans Health Administration, Washington, DC USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">District de Columbia</region>
</placeName>
<wicri:cityArea>Office of Primary Care Clinic Operations, Veterans Health Administration, Washington</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Yano, Elizabeth M" sort="Yano, Elizabeth M" uniqKey="Yano E" first="Elizabeth M." last="Yano">Elizabeth M. Yano</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff7">Department of Health Policy and Management, UCLA School of Public Health, Los Angeles, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>Department of Health Policy and Management, UCLA School of Public Health, Los Angeles</wicri:cityArea>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">24715394</idno>
<idno type="pmc">4070226</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070226</idno>
<idno type="RBID">PMC:4070226</idno>
<idno type="doi">10.1007/s11606-013-2691-y</idno>
<date when="2014">2014</date>
<idno type="wicri:Area/Pmc/Corpus">000153</idno>
<idno type="wicri:Area/Pmc/Curation">000153</idno>
<idno type="wicri:Area/Pmc/Checkpoint">000227</idno>
<idno type="wicri:Area/Ncbi/Merge">000515</idno>
<idno type="wicri:Area/Ncbi/Curation">000515</idno>
<idno type="wicri:Area/Ncbi/Checkpoint">000515</idno>
<idno type="wicri:doubleKey">0884-8734:2014:Farmer M:challenges:facing:primary</idno>
<idno type="wicri:Area/Main/Merge">000240</idno>
<idno type="wicri:Area/Main/Curation">000240</idno>
<idno type="wicri:Area/Main/Exploration">000240</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes</title>
<author><name sortKey="Farmer, Melissa M" sort="Farmer, Melissa M" uniqKey="Farmer M" first="Melissa M." last="Farmer">Melissa M. Farmer</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Rose, Danielle E" sort="Rose, Danielle E" uniqKey="Rose D" first="Danielle E." last="Rose">Danielle E. Rose</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Rubenstein, Lisa V" sort="Rubenstein, Lisa V" uniqKey="Rubenstein L" first="Lisa V." last="Rubenstein">Lisa V. Rubenstein</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff2">Division of General Internal Medicine and Health Services Research, David Geffen UCLA School of Medicine, Los Angeles, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>Division of General Internal Medicine and Health Services Research, David Geffen UCLA School of Medicine, Los Angeles</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff3">RAND Health, Santa Monica, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>RAND Health, Santa Monica</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff4">Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, Sepulveda, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, Sepulveda</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Canelo, Ismelda A" sort="Canelo, Ismelda A" uniqKey="Canelo I" first="Ismelda A." last="Canelo">Ismelda A. Canelo</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Schectman, Gordon" sort="Schectman, Gordon" uniqKey="Schectman G" first="Gordon" last="Schectman">Gordon Schectman</name>
<affiliation wicri:level="2"><nlm:aff id="Aff5">Office of Patient Care Services, Veterans Health Administration, Washington, DC USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">District de Columbia</region>
</placeName>
<wicri:cityArea>Office of Patient Care Services, Veterans Health Administration, Washington</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Stark, Richard" sort="Stark, Richard" uniqKey="Stark R" first="Richard" last="Stark">Richard Stark</name>
<affiliation wicri:level="2"><nlm:aff id="Aff6">Office of Primary Care Clinic Operations, Veterans Health Administration, Washington, DC USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">District de Columbia</region>
</placeName>
<wicri:cityArea>Office of Primary Care Clinic Operations, Veterans Health Administration, Washington</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Yano, Elizabeth M" sort="Yano, Elizabeth M" uniqKey="Yano E" first="Elizabeth M." last="Yano">Elizabeth M. Yano</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1">VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA 91343 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda</wicri:cityArea>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="Aff7">Department of Health Policy and Management, UCLA School of Public Health, Los Angeles, CA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
<wicri:cityArea>Department of Health Policy and Management, UCLA School of Public Health, Los Angeles</wicri:cityArea>
</affiliation>
</author>
</analytic>
<series><title level="j">Journal of General Internal Medicine</title>
<idno type="ISSN">0884-8734</idno>
<idno type="eISSN">1525-1497</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><title>ABSTRACT</title>
<sec><title>BACKGROUND</title>
<p>While the potential of patient-centered medical homes (PCMH) is promising, little is known empirically about the frontline challenges that primary care (PC) leaders face before making the decision to implement PCMH, let alone in making it a reality.</p>
</sec>
<sec><title>OBJECTIVE</title>
<p>Prior to the design and implementation of the Veterans Health Administration’s (VA) national PCMH model—Patient Aligned Care Teams (PACT)—we identified the top challenges faced by PC directors and examined the organizational and area level factors that influenced those challenges.</p>
</sec>
<sec><title>DESIGN AND PARTICIPANTS</title>
<p>A national cross-sectional key informant organizational survey was fielded to the census of PC directors at VA medical centers and large community-based outpatient clinics (final sample n = 229 sites).</p>
</sec>
<sec><title>MAIN MEASURES</title>
<p>PC directors were asked to rate the degree to which they faced 48 management challenges in eight PCMH-related domains (access, preventive care, chronic diseases requiring care in PC, challenging medical conditions, mental health/substance abuse, special populations, PC coordination of care, and clinical informatics). Responses were dichotomized as moderately-to-extremely challenging versus somewhat-slightly-not at all challenging. Items were rank ordered; chi square or regression techniques were used to examine variations in facility size, type, urban/rural location, and region.</p>
</sec>
<sec><title>KEY RESULTS</title>
<p>On average, VA PC directors reported 16 moderate-to-extreme challenges, and the top 20 challenges spanned all eight PCMH domains. Four of the top 20 challenges, including the top two challenges, were from the clinical informatics domain. Management of chronic non-malignant pain requiring opiate therapy was the third most reported challenge nationwide. Significant organizational and area level variations in reported challenges were found especially for care coordination.</p>
</sec>
<sec><title>CONCLUSIONS</title>
<p>Better understanding of PC challenges ahead of PCMH implementation provides important context for strategic planning and redesign efforts. As a national healthcare system, the VA provides a unique opportunity to examine organizational and area determinants relevant to other PCMH models.</p>
</sec>
</div>
</front>
</TEI>
<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Californie</li>
<li>District de Columbia</li>
</region>
</list>
<tree><country name="États-Unis"><region name="Californie"><name sortKey="Farmer, Melissa M" sort="Farmer, Melissa M" uniqKey="Farmer M" first="Melissa M." last="Farmer">Melissa M. Farmer</name>
</region>
<name sortKey="Canelo, Ismelda A" sort="Canelo, Ismelda A" uniqKey="Canelo I" first="Ismelda A." last="Canelo">Ismelda A. Canelo</name>
<name sortKey="Rose, Danielle E" sort="Rose, Danielle E" uniqKey="Rose D" first="Danielle E." last="Rose">Danielle E. Rose</name>
<name sortKey="Rubenstein, Lisa V" sort="Rubenstein, Lisa V" uniqKey="Rubenstein L" first="Lisa V." last="Rubenstein">Lisa V. Rubenstein</name>
<name sortKey="Rubenstein, Lisa V" sort="Rubenstein, Lisa V" uniqKey="Rubenstein L" first="Lisa V." last="Rubenstein">Lisa V. Rubenstein</name>
<name sortKey="Rubenstein, Lisa V" sort="Rubenstein, Lisa V" uniqKey="Rubenstein L" first="Lisa V." last="Rubenstein">Lisa V. Rubenstein</name>
<name sortKey="Rubenstein, Lisa V" sort="Rubenstein, Lisa V" uniqKey="Rubenstein L" first="Lisa V." last="Rubenstein">Lisa V. Rubenstein</name>
<name sortKey="Schectman, Gordon" sort="Schectman, Gordon" uniqKey="Schectman G" first="Gordon" last="Schectman">Gordon Schectman</name>
<name sortKey="Stark, Richard" sort="Stark, Richard" uniqKey="Stark R" first="Richard" last="Stark">Richard Stark</name>
<name sortKey="Yano, Elizabeth M" sort="Yano, Elizabeth M" uniqKey="Yano E" first="Elizabeth M." last="Yano">Elizabeth M. Yano</name>
<name sortKey="Yano, Elizabeth M" sort="Yano, Elizabeth M" uniqKey="Yano E" first="Elizabeth M." last="Yano">Elizabeth M. Yano</name>
</country>
</tree>
</affiliations>
</record>
Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Ticri/CIDE/explor/CyberinfraV1/Data/Main/Exploration
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000240 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd -nk 000240 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien |wiki= Ticri/CIDE |area= CyberinfraV1 |flux= Main |étape= Exploration |type= RBID |clé= PMC:4070226 |texte= Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes }}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Exploration/RBID.i -Sk "pubmed:24715394" \ | HfdSelect -Kh $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd \ | NlmPubMed2Wicri -a CyberinfraV1
![]() | This area was generated with Dilib version V0.6.25. | ![]() |