: Introduction
The healthcare system in the United Statesis challenged with unsustainable
increasing costs, unwarranted variation in quality of care, and low patient and provider
satisfaction (Barr, 2008). Implementing the patient-centered medical home Essay
Current organizational, population, economic, and regulatory
trends emphasize the need for transforming the health care system from a specialized and
fragmented system of siloed medical professionals to a coordinated and interdependent
system of teams of medical professionals emphasizing primary care, health promotion,
and disease prevention (Benatar, Bondmass, Ghitelman, & Avitall, 2003; Starfield, Shi,
& Macinko, 2005; Institute of Medicine [IOM], 2001; Reid et al., 2009). The PatientCentered Medical Home (PCMH) has been set forth as a promising model of practice
redesign in this transformation. However, the complexity involved in implementing the
PCMH model into primary care practice has proven to be quite challenging (Nutting,
Crabtree, Miller et al., 2011).Implementing the patient-centered medical home Essay Paper.
Although the general concept of the medical home has existed for decades, its
advocate base has expanded in recent years (Backer, 2007). Payers and policymakers are
exerting increasing pressure to adopt the PCMH model, presenting a considerable
undertaking for provider organizations (Nutting et al., 2009). Despite myriad
demonstration projects studying PCMH implementation and practice transformation,
limited empirical investigation has focused on dynamic factors in the organizational.Implementing the patient-centered medical home Essay Paper.
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context (Crabtree, Nutting, Miller et al., 2010; Carrier, Gourevitch, & Shah, 2009).
Implementation and organizational scholars alike posit the importance of understanding
organizational context and the fidelity with which innovation is implemented to bring
forth insight about how organizations achieve implementation and change (Damschroder
et al., 2009; Douglas & Judge, 2001; Feldman & Orlikowski, 2011). This introductory
chapter presents the specific aims of this dissertation and the overarching conceptual
framework that guided this research to contribute to understanding PCMH
implementation.Implementing the patient-centered medical home Essay Paper.
Central to this research is the exploration and understanding of how PCMH
implementation occurs in practice. Implementation is defined as the dynamic
organizational process that occurs between the organizational decision to adopt an
innovation and the innovation’s assimilation into ongoing organizational practices; it is
the transition period during which organizational members incorporate an innovation into
sustained use (Klein & Sorra, 1996). Implementing the patient-centered medical home Essay Paper.The following considerations of PCMH
implementation provide the motivation for this research. First, variation in the fidelity
with which the PCMH is implemented in different provider organizations is not well
understood, because of the paucity of in-depth qualitative investigations of PCMH
transformation (motivation for Essay #1) (Jaén et al., 2010). Second, organizational
capacity for learning and development has been advocated to achieve PCMH
implementation (Nutting, Crabtree, Miller, et al., 2010).Implementing the patient-centered medical home Essay Paper. However, the occurrence of
organizational learning during achievingPCMH implementation has not been
systematically studied (motivation for Essay #2). Finally, despite myriad demonstration
projects investigating PCMH transformation, an implementation science approach has not
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been used to understand contextual factors that may influence PCMH implementation
(motivation for Essay #3).Implementing the patient-centered medical home Essay Paper.
Specific Aims
Essay # 1: Understanding Variation in Patient-Centered Medical Home Implementation:
A Qualitative Study of Fidelity
Frameworks guided by organizational theory and implementation science are
necessary to study PCMH transformation. Drawing from organizational theory literature,
prior investigations of implementation comparable to PCMH, Total Quality Management
(TQM) being the most prominent example, by and large focus on organizational level
factors such as those associated with top management’s adoption decision (Hackman &
Wageman, 1995).