Practice Redesign: Do physicians want the patient-centered medical home?

Prior to initiation of a project to certify three General Internal Medicine (GIM) clinics as a Patient Center Medical Home, a three-round Delphi iterative questionnaire was administered to thirty-one faculty members, all of whom practice in an academic general internal medicine clinic. In Round 1, physicians were asked five open ended questions regarding roles, responsibilities, and, following the PCMH model, additional services to be provided to patients. Twelve physicians in the Family Medicine (FM) Department also participated in the first round.

Round 1 responses from 36 GIM physicians were sorted into 8 major categories and the responses of FM physicians fell into 3 major categories. For Round 2, the panel of GIM physicians rated the items within categories as to their importance on a five-point Likert scale. For Round 3, the physicians had the opportunity to rank-order the items and return any excluded items. The Family Medicine Clinic is about to begin Round 2.

For the GIM physician responses, of the 55 items in the final list for round 2, 45 were matched to a specific NCQA element.

Conclusion: The vast majority of physician generated ideas of how to improve care in a general internal medicine practice that match the National Committee for Quality Assurance (NCQA) criteria for the certification of the practice as a patient-centered medical home. The process of letting physicians identify areas to improve practice may ease the changes required for practice redesign in the development of a patient-centered medical home.