Building a patient-centered medical home: obtaining the patient's voice.

Purpose: Many primary care practices are currently attempting to transform into patient-centered medical homes (PCMHs), but little is known about how patients view aspects of the PCMH or how they define patient-centeredness.

Methods: We conducted 3 focus groups with patients from urban academic internal medicine practices. We asked questions about patients' perceptions of what patient-centered care should be; care quality, teams and access; diabetes self-management; and community connections and services. We used a grounded theory approach to the analysis.

Results: The global themes that arose in our focus groups included the desire for timely, clear, and courteous communication; a practice that is structured to facilitate an ongoing relationship with a provider who knows the patient; and a relationship that allows the patient both to trust the provider's guidance and to engage more fully in his or her own care.

Conclusions: Our patients want a provider to know them personally and to take time to listen to their issues. They feel that they cannot access their providers in a timely fashion, find our automated phone systems frustrating, and want more time with their provider. Although the technological and structural implementation of the PCMH requires considerable effort and resources, we cannot neglect the relationships we have with our patients. Patients should be involved in this process of change to ensure we address their concerns and preserve the primary care relationships they value.