Objective: To examine perspectives of physicians serving children with special health care needs (CSHCN) related to two questions: Did physicians and practices undergo explicit changes in order to achieve the highest level of National Committee for Quality Assurance (NCQA) patient-centered medical home (PCMH) recognition?; Did these changes lead to higher quality care for CSHCN?
Methods: Semi-structured discussions with 20 pediatricians and family physicians at practices that achieved NCQA Level 3 PCMH-recognition prior to 2011. We coded notes and identified themes using an iterative process and pattern recognition analysis.
Results: Physicians reported being motivated to seek PCMH-recognition by a combination of altruistic and practical goals. Most said recognition acknowledged already existing practice characteristics, but a few, in smaller practices, reported substantial transformation. Few physicians had seen information to help them assess the impact of being a PCMH on utilization and outcomes. Many said recognition helped practices improve financial arrangements with payers and participate in quality initiatives. Challenges in providing care for CSHCN included identifying a population with heterogeneous diagnoses and needs, communicating with other providers and health systems, and building sustainable care coordination procedures.
Conclusions: PCMH-recognition can be valuable to practices as public acknowledgement to payers and patients that certain procedures and processes are in place; it can also catalyze new and continued transformation. Programs and policies seeking to transform primary care for CSHCN may consider leveraging physicians' motivations and finding creative mechanisms to help practices build internal care management systems and linkages with the medical neighborhood.
What's New: Little is known about how formal medical home recognition influences primary care practice transformation. In this study of early-adopters, recognition largely acknowledged what practices were already doing but was a catalyst for practice transformation in a few smaller practices.
Key Words: Patient-centered medical home, children with special health care needs, primary care, practice transformation, medical home recognition.