Implementing the patient-centered medical home Essay Paper.

: 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

ORDER  HERE A PLAGIARISM-FREE PAPER HERE

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.
2
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
3
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).Implementing the patient-centered medical home Essay Paper. As a consequence, studies assume that the intra-organizational process
of implementation will have minimal variation across different organizations once the
adoption decision has been made (Ansari, Fiss, & Zajac, 2010). TQM scholars have
begun to examine intra-organizational dynamics of TQM implementation and the
association with organizational outcomes, and they recommend including a measure of
fidelity (Douglas & Judge, 2001). Current knowledge of PCMH implementation largely
rests on the assumption that homogeneous implementation will follow the adoption of the
PCMH model by provider organizations. If provider organizations are to successfully
implement the PCMH model to achieve improved outcomes, a holistic assessment of the
model is necessary to understand the extent to which changes are operationalized in
practice (Jaén et al., 2010).
Specific Aim: To understand how PCMH implementation varies across primary care
clinics.Implementing the patient-centered medical home Essay Paper.
4
Essay # 2: Creating Organizational Learning Capacity to Promote Patient-Centered
Medical Home Implementation: Findings from a Qualitative Study
PCMH transformation is more than the implementation of incremental changes,
but requires “epic whole-practice re-imagination and redesign,” which can be
compromised by change fatigue among clinicians and staff, even in highly motivated
practices (Nutting et al., 2009). The intra-organizational practice context in which
clinicians and staff interact with each other and with the PCMH operational infrastructure
is an important aspect of PCMH implementation in need of further investigation (Nutting,
Crabtree, Miller, et al., 2010; Wise, Alexander, Green, Cohen, & Koster, 2011).Implementing the patient-centered medical home Essay Paper. While
the majority of recommendations made from investigations of PCMH transformation
assess organizational level factors, they do not describe intra-organizational factors
associated with change that are accessible to practitioners challenged with PCMH
implementation.Correspondingly, organizational scholars call for additional research to
discern howsuccessful implementation occurs within organizations and to identify the
intra-organizational factors associated with variation in implementation between
organizations (Cool, Dierickx, & Szulanski, 1997; O’Mahoney, 2007).Implementing the patient-centered medical home Essay Paper.
Organizational learning theory has been used to investigate underlying intraorganizational contextual factors associated with change and implementation
(Edmondson, Bohmer, & Pisano, 2001; Garud, Dunbar, & Bartel, 2011; Leykeum et al.,
2011). Organizational learning mechanisms are arrangements within an organizational
structure that support the processes through which individuals adapt their behaviors and
actions to align with organizational changes and goals(Lipshitz & Popper, 2000).
Organizational learning mechanisms enable individual-level learning (i.e. understanding.Implementing the patient-centered medical home Essay Paper.
5
of the individual’s role in the organization) and organizational-level learning (e.g.
adapting organizational protocols and work processes), and therefore can account for an
organization’s capacity for change.
Specific Aim: To explore organizational learning mechanisms in primary care delivery
that are associated with PCMH implementation and to describe the characteristics that
differ across variation in PCMH implementation.
Essay # 3:An Exploration of Differences in Contextual Factors Related to Fidelity to the
Patient-Centered Medical Home
PCMH research is limited in the use of an implementation science approach to
inform PCMH implementation efforts (Reid et al., 2009; Barr, 2008; Nutting et al.,
2009). An implementation science approach can contribute to understanding variation in
how or why some organizations implementing a complex model of care delivery such as
the PCMH achieve more consistent, high-quality, and appropriate use (i.e. higher fidelity)Implementing the patient-centered medical home Essay Paper.
than others (Weiner, Lewis, & Linnan, 2009). Implementation theory is comprised of a
broad scope of organizational contextual factors that may influence the level of fidelity
with which an intervention is used in practice (Greenhalgh, Robert, MacFarlane, Bate, &
Kyriakidou, 2004). Therefore a comprehensive an assessment of the organizational
context in which implementation occurs is necessary to understand how a high level of
fidelity to the PCMHis achieved.
Specific Aim: To identify and qualitatively describe organizational contextual factors
associated with variation in fidelity to the PCMH in primary care clinics.Implementing the patient-centered medical home Essay Paper.

A patient-centered medical home (PCMH) is a coordinated and collaborative model of healthcare delivery that uses a multidisciplinary to care (Flieger, 2017). This approach to care has proven to be effective in reducing medical costs, improving the coordination of care, efficiency, safety, and clinical outcomes for patients.Implementing the patient-centered medical home Essay Paper.

PCMH increase the engagement of patients and healthcare providers in a therapeutic relationship and also improves quality of care and the experience of clients (Loversidge, 2016). The maintenance of patient safety through provision of quality healthcare services is a significant concern in el Paso Texas particularly in managed care organizations where multidisciplinary practice is essential. There are various nursing regulations that affect my practice as they are designed as simple registry processes to protect the public and guarantee safety of care within the purview of an HCCC. Examples of the regulations include the standards of environmental health and regulations on resource utilization, collaboration, and professional practice evaluation.Implementing the patient-centered medical home Essay Paper.

A significant example of an accreditation that affects my practice is one instituted by the Commission of Collegiate Nursing Education (CCNE) which is an autonomous agency that accredits and facilitates public health safety. Electronic Health Records are currently being incorporated in various managed care systems to reduce instances of missed documentation and errors and enhance patients’ safety (Flieger, 2017). The Hierarchical Condition Category Coding (HCCC) and proper documentation within the purview of electronic health records can be used to enhance patient safety through maintenance of effective patient records.Implementing the patient-centered medical home Essay Paper.

In conclusion, a PCMH is a critical model in healthcare delivery that facilitates the provision of cost-effective and quality care to all patients. Documentation in Wellmed Medical Management can be enhanced by reinforcing privacy policies in the current coding systems. Implementing the patient-centered medical home Essay Paper.