Although the medical home concept emerged in the 1960s as a model for improving care for children with special health care needs (CSHCN), policy interest in the medical home has accelerated in recent decades within and outside of pediatrics.1, 2, 3 Early evidence suggests that organizing primary care practices as patient-centered medical homes (PCMHs) has the potential to improve quality and reduce total health care costs in a variety of patient populations,4, 5, 6, 7 and primary care medical societies, payers, providers, and consumer groups endorse the model.8, 9, 10 Pediatric practices that have implemented components of the PCMH model may provide better care to CSHCN than those without such components.11, 12
A number of organizations have emerged to recognize practices as PCMHs. This process is much like an accreditation process through which practices are recognized if they meet specific criteria. Although multiple organizations offer processes to recognize primary care practices as PCMHs, the National Committee for Quality Assurance (NCQA) has emerged as the "market leader"13 and its guidelines have become the de facto standard for many transformation efforts. Although the number of practices obtaining PCMH-recognition from NCQA has increased quickly, few studies have examined the extent to which physicians in such practices believe the recognition process influenced practice transformation and care quality for CSHCN.
The objective of this study was to examine the perspectives of primary care physicians who serve CSHCN on changes they and their practices made in order to achieve the highest level of NCQA PCMH-recognition. Specifically, the study used information from physicians in pediatric and family practices that obtained Level 3 NCQA PCMH-recognition prior to 2011 to address two questions: (1) Did physicians and practices undergo any explicit changes in order to achieve PCMH-recognition? (2) Did any of the changes lead to higher quality care for CSHCN?