Findings From the AHRQ Transforming Primary Care Grant Initiative: A Synthesis Report

The patient-centered medical home (PCMH) (also referred to as primary care medical home,medical home, health care home, or advanced primary care) is a model for redesigning primary care in the United States to improve health care quality, reduce costs, and better address the needs of patients and families. In recent years, numerous health care systems and medical groups across the country have worked to transform their primary care practices into PCMHs. Although a number of definitions exist, efforts to transform into a PCMH go beyond quality improvement, and generally aim to transform both the organization and the delivery of primary care. The Agency for Healthcare Research and Quality (AHRQ) defines a PCMH as having the following five attributes: 1) comprehensive care, 2) patient-centered care, 3) coordinated care, 4) accessible services, and 5) quality and safety, and recognition of the central role of health information technology (IT) in successfully operationalizing and implementing the key features of the medical home. Additional information about how AHRQ defines these attributes is available at: http://pcmh.ahrq.gov/page/defining-pcmh.

In 2010, AHRQ awarded 14 Transforming Primary Care Practice (TPC) grants to examine the processes, determinants, and impacts of primary care transformation. These studies were all retrospective evaluations of successfully implemented or ongoing PCMH transformation efforts. The 14 studies varied considerably in terms of the size, type, and number of primary care practices studied, as well as their geographic location. At least in part because of the variation, the way in which transformation was implemented across these practices also differed greatly, as did the evaluation of each of these efforts. Consequently, it would not have been feasible to identify which methods of implementation were most effective by comparing across projects. However, a review of the findings and lessons learned across the 14 studies revealed a number of common themes that can be helpful for future primary care transformation efforts.

McNellis and colleagues began summarizing the common themes across the grants at the end of funding in a paper titled “Lessons learned from the study of primary care transformation.”¹ The paper highlighted the following five key lessons learned: 1) a strong foundation is needed for successful redesign; 2) the process of transformation can be a long and difficult journey; 3) approaches to transformation vary; 4) visionary leadership and a supportive culture ease the way for change; and 5) contextual factors are inextricably linked to outcomes. In this report, we build upon McNellis’ effort to synthesize key findings across grants, adding additional insights from findings included in the studies’ final reports as well as from manuscripts that have been published based on these grants (a full list of papers published by the TPC investigators as of January 1, 2015 is available at: www.ahrq.govncepcr/research-transform-primary-care/transform/tpcbib/index.html).