"We've not gotten even close to what we want to do": a qualitative study of early patient-centered medical home implementation.

Background: The Veterans Health Administration (VA) Patient Aligned Care Teams (PACT) initiative is designed to deliver a medical home model of care associated with better patient outcomes, but success will depend in part on the model's acceptability and sustainability among clinic employees.

Objective: We sought to identify key themes in the experience of primary care providers, nurse care managers, clerical and clinical associates, and clinic administrators implementing PACT, with the aim of informing recommendations for continued development of the model and its components.

Design: Observational qualitative study; data collection from 2010 to 2013, using role-stratified and team focus groups and semi-structured interviews.