Practice transformation in teaching settings: lessons from the I³ PCMH collaborative.

Background: The Patient-centered Medical Home (PCMH) model provides a roadmap for practices engaged in practice transformation to improve quality, accessibility, and satisfaction. Primary care residencies can use these principles to transform their practices, but it is unclear how best to facilitate this transformation. This paper describes the design, implementation, and initial outcomes of an academic PCMH collaborative.

Methods: The I³ PCMH Collaborative adapted the Institute for Healthcare Improvement's Breakthrough Collaborative model to facilitate practice transformation in 25 primary care teaching sites across North Carolina, South Carolina, and Virginia. The National Committee for Quality Assurance (NCQA) PCMH Recognition Program provided the goal and outcome measures. Surveys at baseline, midpoint, and end of the 20-month collaborative period, as well as activity assessments, described practice characteristics, tracked progress, and identified key lessons.

Results: Twelve programs (48%) achieved NCQA PCMH recognition or submitted applications during the collaborative, and nine programs (36%) planned to submit applications by July 2011. A majority of programs characterized improvements toward becoming a PCMH as "significant" (56%) or "sustainable" (12%). Sixteen (64%) programs credited the collaborative with helping to maintain focus on practice transformation in the face of competing priorities. Twenty-one (84%) programs indicated willingness to participate in a future practice improvement collaborative.

Conclusions: A heterogeneous group of primary care residency programs working together can achieve substantial, measurable improvement toward becoming PCMHs, with a modest investment in collaborative infrastructure.