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Research ArticleOriginal Research

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon

Sherril Gelmon, Nicole Bouranis, Billie Sandberg and Shauna Petchel
The Journal of the American Board of Family Medicine May 2018, 31 (3) 334-341; DOI: https://doi.org/10.3122/jabfm.2018.03.170265
Sherril Gelmon
From Oregon Health and Sciences University-Portland State University School of Public Health, Portland OR (SG, NB, SP); Mark O. Hatfield School of Government, Portland State University, Portland (BS).
DrPH
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Nicole Bouranis
From Oregon Health and Sciences University-Portland State University School of Public Health, Portland OR (SG, NB, SP); Mark O. Hatfield School of Government, Portland State University, Portland (BS).
MA
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Billie Sandberg
From Oregon Health and Sciences University-Portland State University School of Public Health, Portland OR (SG, NB, SP); Mark O. Hatfield School of Government, Portland State University, Portland (BS).
PhD
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Shauna Petchel
From Oregon Health and Sciences University-Portland State University School of Public Health, Portland OR (SG, NB, SP); Mark O. Hatfield School of Government, Portland State University, Portland (BS).
MPH
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    Table 1.

    Core Attributes of the Patient-Centered Primary Care Home Program11

    Core AttributeDescription
    AccessPatients get the care they need when they need it
    AccountabilityClinics are responsible for making sure patients receive the best possible care
    Comprehensive, whole-person careClinics provide patients all the care, information, and services they need
    ContinuityClinics work with patients and their community to improve patient and population health outcomes over time
    Coordination and integrationClinics help patients navigate the system to meet their needs in a safe and timely way
    Patient and family centeredPatients are the most important members of the health care team and are ultimately responsible for their overall health and wellness
    • View popup
    Table 2.

    Characteristics and Numbers of Selected Clinics

    GeographySize (Full-Time Equivalent, FTE)Ownership/AffiliationPractice SpecialtyRegion
    Rural5≤2 FTE primary practitioners1Independent and unaffiliated with any other clinics12Family Medicine14*Columbia Willamette11
    Urban small43 to 5 FTE primary practitioners4Independent and part of an alliance of clinics1Internal Medicine3*Cascades East2
    Urban medium66 to 9 FTE primary practitioners5Owned by a larger health system7Pediatric4Oregon Pacific6
    Urban large5≥10 FTE primary practitioners10Northeast Oregon1
    • ↵* One clinic specialized in both family medicine and internal medicine.

    • View popup
    Table 3.

    Strategies in Response to Common Implementation Challenges

    Key ChallengeStrategy
    Shifting patterns of care use• Expanding access through teams, schedules, and staffing
    • Preventing unnecessary emergency department visits through patient outreach and emergency department information exchange
    • Ensuring care with outside providers through improved communication and referral tracking
    Fidelity to the PCPCH model• Prioritization of select standards and metrics
    • Implementing patient-centered practices including bilingual/bicultural staff, cultural competency training, and new population demographic metrics
    • Developing new continuous improvement capacity through committees, training, and clinic “champions”
    Refining care processes• Incorporating screenings, preventive services, and chronic disease management
    • Standardization of workflows
    • Customizing electronic health records for communication and reporting
    • Integration of mental health
    • PCPCH, patient-centered primary care homes.

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The Journal of the American Board of Family     Medicine: 31 (3)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 3
May-June 2018
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Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon
Sherril Gelmon, Nicole Bouranis, Billie Sandberg, Shauna Petchel
The Journal of the American Board of Family Medicine May 2018, 31 (3) 334-341; DOI: 10.3122/jabfm.2018.03.170265

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Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon
Sherril Gelmon, Nicole Bouranis, Billie Sandberg, Shauna Petchel
The Journal of the American Board of Family Medicine May 2018, 31 (3) 334-341; DOI: 10.3122/jabfm.2018.03.170265
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Keywords

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