全球智库信息集成服务系统

Leadership Facilitates Implementation

• Strong leaders successfully oversaw the implementation of cultural and process changes while ensuring that patient needs guided their efforts.

A Dedicated Team Is Essential

• A team spanning multiple disciplines, including senior staff, and working to secure staff buy-in for proposed changes can guide the effort to a successful result.
• Staff shortages limited the ability to expand access and use empanelment and multidisciplinary care teams. A dedicated implementation team that provides consistent messaging can help maintain forward progress.

Consistent Communication Can Secure Buy-In

• Engaging staff, sharing data, and communicating successes can encourage staff to pursue continuous process improvements.
• Working with tribal leaders and the community can secure buy-in for major changes, leverage community assets, and build trust.

Program Tools Are Valuable

• The IPC tools were appreciated, but support from IHS Area Offices varied. Some clinics reported that their area-level improvement support teams were not able to consistently provide the level of assistance needed.

Assessing Needs Focuses Efforts

• Knowing a clinic's population was essential in meeting their needs.
• Analyzing clinic expenditures and other providers' availability could determine ways to spend resources more efficiently.

Smaller Clinics May Need More Assistance

• Smaller clinics suffered disproportionately from staff turnover, reported a limited ability to apply for grants, and described shortages of staff with expertise in quality improvement, data analytics, or use of the iCare system.

Third-Party Revenue Is Critical

• Additional revenue, particularly from Medicaid reimbursements, helped clinics hire more staff, expand access, and invest in improvements.

The Overall Impact Is Positive

• The clinics reported positive feedback from staff, high performance on quality measures, and improvements in patient satisfaction and access to care.

In an effort to provide care that is more accessible, team-based, coordinated, and patient-focused, primary care practices are increasingly adopting patient-centered medical home (PCMH) models of care. In 2008, the Indian Health Service (IHS) launched its own PCMH initiative, Improving Patient Care (IPC), to improve the quality of care for American Indians and Alaska Natives (AI/ANs) who seek care in its clinics. The IHS provides comprehensive health care services to roughly 2.2 million AI/ANs from more than 567 federally recognized tribes across the United States.

In this report, RAND researchers examine the peer-reviewed and grey literature and identify common PCMH implementation strategies and challenges to better understand the kinds of methods used by clinics across the United States — particularly small clinics and those located in rural or remote locations. The research team then held telephone discussions with representatives from seven IHS clinics that had received PCMH recognition as of July 2017. The discussions with clinic leaders sought to identify how components of the PCMH model had been implemented at their clinics; challenges associated with PCMH implementation; and key lessons and recommendations that could benefit clinics that have not yet received PCMH recognition.

• Chapter One

  Introduction

• Chapter Two

  PCMH-Recognized Clinics Participating in the Study

• Chapter Three

  PCMH Implementation Strategies and Challenges

• Chapter Four

  Lessons Learned and Recommendations for Clinics in Pursuit of PCMH Recognition

• Chapter Five

  Conclusion

• Appendix A

  Implementation and Impact of Patient-Centered Medical Homes: Literature Review

• Appendix B

  Discussion Guide