Practice Leaders Report Targeting Several Types of Changes in Care Experienced by Patients During Patient-Centered Medical Home Transformation.

Patient-centered medical home (PCMH) has spurred primary care reform and improvements in patient care quality. Very little is known about the differences practices implement during PCMH transformation. We examined 105 primary care practice leader experiences during PCMH transformation, asking in semi-structured interviews about the changes they targeted. We used content analysis to classify these PCMH changes and examined how they aligned with what is measured on PCMH-recommended patient experience surveys. During PMCH transformation, practices most commonly targeted changes in care coordination (30%), access to care (25%), and provider communication (24%). Reported areas of PCMH transformation were measured by Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CAHPS), PCMH CAHPS, or supplemental CAHPS survey items, including team-based care (35%), providing more services on site (28%), care management (22%), patient-centered culture (18%), and chronic condition health education (13%). Many PCMH changes are captured by CAHPS patient experience items; some are not. For some uncaptured areas, patients are not the best source of information. To provide practice leaders information they need for PCMH transformation, CAHPS items need to measure care management to support medical and chronic conditions, and chronic condition health education.