Online Program

Getting from here to there: Application of implementation science to a patient-centered medical home program

Tuesday, November 5, 2013 : 4:30 p.m. - 4:50 p.m.

Jill Rissi, PhD, OHSU & PSU School of Public Health, Portland State University, Portland, OR
Robin Baker, MS, Mark O. Hatfield School of Government, Portland State University, Portland, OR
Phyusin Myint, MPA, Mark O. Hatfield School of Government, Portland State University, Portland, OR
To evaluate the development, implementation and efficacy of the Patient Centered Medical Home Model; identify factors which influence its success; and identify potential modifications to statutes or administrative rules that further health system transformation goals. Methods include semi-structured interviews and document analysis based on an implementation science framework. Findings suggest that internal opinion leaders and external change agents may mitigate resistance and facilitate support for the Program among administrative entities and clinical sites. Findings also indicate that financial incentives were a challenge to implementation; critical incentive for participation; and important factor influencing the pace of progress. Although consumer engagement is a key element of the program, evidence for, and the efficacy of such involvement is mixed. The enabling legislation itself appears to be a crucial element for defining program intent, incentives, processes and expectations; and is complemented by structured administrative rules and agency policies. Finally, eligibility criteria, certification metrics, and payment processes and systems influence participation at the clinic level. Our analysis highlights the relative influence of statutes, administrative rules, department policies, accountability metrics, and payment systems as unique elements that both define and influence the implementation of PCMH programs. Clearly articulating statutory intent, program structure, and accountability processes can facilitate implementation, particularly under conditions in which timelines are short and service providers must coordinate multiple system reform initiatives. While financial support is critical to efforts to incentivize coordination among physical, behavioral and oral healthcare providers, clarity of policy intent, authority and technical assistance are necessary to ensure successful implementation.

Learning Areas:

Administration, management, leadership
Implementation of health education strategies, interventions and programs
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe five evaluation domains for assessing implementation of a patient-centered medical home model in a state Medicaid program. Discuss the utilization of an implementation science framework, and analyze the relative importance of the factors that may facilitate, or impede successful implementation of a PCMH Program.

Keyword(s): Health Care Reform, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator of a comprehensive evaluation of Oregon's Patient-Centered Primary Care Home Program and lead researcher on the qualitative arm of that study, and have conducted similar research on numerous other health policies and programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.