The Institute of Medicine evaluated the U.S. health system in the 1990s and found an extremely expensive system with clinical outcomes that were ranked lower than a number of other industrialized nations. (Institute of Medicine, 2001) In addition, the per capita spending was almost double that of other nations. The U.S. health care system was fragmented, highly technical, and specialty oriented. Even though the primary care system is the backbone of more efficient and less expensive systems in other countries (Landon, Gill, Antodelli, & Rich, 2010). The primary care system was in a downward spiral in terms of morale and number of U.S. medical students entering primary care specialties. To respond to the call of the Institute of Medicine and the ongoing decline of primary care residents, seven primary care organizations including the American Academy of Family Physicians and the American Board of Family Medicine, published a report called the “Future of Family Medicine” (Kahn, 2004). The report described a new model of family medicine called the patient-centered medical home (PCMH). The model needed to be standardized to evaluate outcomes. Three bodies provide certification: the Joint Commission, the Accreditation Commission for Health Care, and the National Committee for Quality Assurance (NCQA) (Klein,, Laugesen, & Liu, 2013). The NCQA is the organization that most of the practices use for recognition (Landon et al., 2010). Various organizations have conducted studies on the implementation PCMH and found the PCMH model took about two years to implement, consumed practice resources but led to improved quality and some indication of lower costs (AHRQ, 2012). To become the future landscape of primary care, the PCMH model depends on small practices adopting it because a large percentage of family practices have fewer than five providers (Scholle, et al., 2013). The Hamilton Family Health Center (HFHC) of Community Memorial Hospital (CMH) is a small center with the equivalent of three and a half full-time providers and two specialists. The CMH recently became a critical access rural hospital certified for 25 beds, whose average daily census is 15-16 patients. This project was a combination of participatory action research (PAR) and insider action research (IAR). The project can be classifed as PAR because the staff, providers, and patients were involved and had significant input. The project is considered IAR as well because the author was also a provider in the center. The project goal was threefold: (a) achieve level three PCMH status for a small health center with markedly limited resources, (b) identify the process taken to meet this goal and how it can be improved and (c) learn what the changes will mean for the center. The Hamilton Family Health Center has achieved level three, but the project is ongoing because achieving the NCQA standards is only a step to achieving an ideal practice.
|Advisor:||Kerr, Bernard J.|
|Commitee:||Dore, Amy K., Johnson, Douglas N.|
|School:||Central Michigan University|
|Department:||DHA - Health Administration/School of Health Sciences|
|School Location:||United States -- Michigan|
|Source:||DAI-B 77/03(E), Dissertation Abstracts International|
|Subjects:||Health care management|
|Keywords:||Action, Centered, Home, Medical, Patient, Research|
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