• Am J Manag Care · Feb 2013

    Medical homes require more than an EMR and aligned incentives.

    • Samantha L Solimeo, Michael Hein, Monica Paez, Sarah Ono, Michelle Lampman, and Greg L Stewart.
    • VISN 23 Patient Aligned Care Team Demonstration Laboratory, Iowa City VA Health Care System, 601 Hwy 6 W, Mailstop 152, Iowa City, IA 52246, USA. Samantha.Solimeo@va.gov
    • Am J Manag Care. 2013 Feb 1; 19 (2): 132-40.

    BackgroundThe Veterans Health Administration (VHA) is changing its primary care delivery by implementing the patient-centered medical home (PCMH).ObjectivesTo evaluate PCMH implementation among 22 newly formed teams working in the VHA.Study DesignLongitudinal formative evaluation of team members' role transformation during the first 18 months of implementation.MethodsWe used 3 sequential, semistructured focus groups to gather data from 4 different groups representing the principal team member roles: primary care providers, registered nurse care managers, licensed practical nurses, and clerical associates.ResultsTeam members identified within-team role and interpersonal conflict, as well as discordant administrative leadership styles, as key implementation challenges.ConclusionsOur results suggest that, in addition to technological and fiscal infrastructure, healthcare leaders implementing the PCMH model must take into account interprofessional issues associated with changes in leadership and the adoption of team-based structures.

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