Practice transformation in the safety net medical home initiative: A qualitative look

Edward H. Wagner, Reshma Gupta, Katie Coleman

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: Transformation of primary care to patient-centered medical homes (PCMH) is challenging. Progress in transformation varied widely among practices involved in the Safety Net Medical Home Initiative Copyright r 2014 by Lippincott Williams & Wilkins.

Objective: To study 3 successful practices to identify common characteristics and approaches.

Research Design: We selected 3 diverse practices based on their improvement on the PCMH-A, a self-assessment instrument measuring progress toward becoming a PCMH. We interviewed 2-3 leaders from the each of 3 practices seeking information about their motivations for transforming, the methods used to make changes, and challenges and facilitators. Interview data were coded, themes developed, and conclusions drawn using qualitative research methods.

Results: For these successful practices, the major motivators were a desire to improve quality of care, patient experience, or provider experience. Financial incentives played a minor role. All practices had engaged, visible leaders driving change, and all ultimately developed an effective quality improvement/practice change strategy that included the provision of trusted performance data at the provider level and an explicit process change strategy. Sequencing the work of PCMH transformation was important, and developing defined provider patient panels and building effective clinical teams facilitated making improvements to access and care delivery.

Conclusions: Practice transformation is disruptive. To be successful, organizations need to have the will or motivation to change, explicit ideas or models on which to base change, and a culture and infrastructure that enables the execution of system changes.

Original languageEnglish (US)
Pages (from-to)S18-S22
JournalMedical care
StatePublished - Nov 10 2014
Externally publishedYes


  • Patient-centered medical home
  • Primary care
  • Quality improvement

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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