Jan posits that one potential explanation for the very modest changes in outcomes despite the practices' success in adopting PCMH components is that "it takes time and additional work to turn a new process into an effective function." "Two years," he suggests, "may not have been enough time to realize substantial improvement in the patient experience."
"The NDP experience suggests that for most practices it will take much more than anyone imagined to transform into a PCMH," concludes Benjamin F. Crabtree, Ph.D. independent evaluator and professor at the UMDNJ Robert Wood Johnson Medical School. "Although it is theoretically feasible to transform independent practices in to the NDP conceptualization of a PCMH, doing so requires a lot of effort, motivation and support, and most practices will need additional time, resources and outside facilitation to achieve the magnitude of redesign envisioned in the PCMH."
With this in mind, the evaluation team recommends lengthening the time allowed for the National Committee for Quality Assurance's PCMH recognition process to five to six years so practices have more time to succeed.
In his article analyzing the practice change process, William L. Miller, M.D., M.A., with the Lehigh Valley Health Network, finds that a practice's capacity for organizational learning and development, or adaptive reserve, is critical to managing the unrelenting, continual change required to implement the PCMH. Notably, none of the self-directed practices with limited adaptive reserve at baseline did well in implementing the NDP model components. This important finding suggests that strengthening adaptive reserve will serve practices well over the next
|Contact: Angela Sharma|
American Academy of Family Physicians