Identifying Best Practices of Medical Home Implementation for Older Adults

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DESCRIPTION (provided by applicant): The proposed study examines how primary care providers (PCP) and nurses implement patient-centered medical home principles (PCMH) for older adults in their practices. It takes a qualitative approach in exploring PCP and nurse experiences with PCMH care for older adults, and in identifying provider beliefs, knowledge, and learning produced by these experiences. The study then links the experiences, beliefs, knowledge, and learning identified to specific strategies, approaches, and activities in which providers engage when attempting to provide one or more PCMH care principles more effectively to their older adult patients. These "implementation best practices" will be categorized by specific PCMH principle and can be validated and applied further across primary care work settings doing medical home care. A total of sixty PCPs and nurses will be interviewed for the project. In addition, two focus groups of PCPs and nurses will be held to help validate and refine the interview findings. The end product of this exploratory study is two-fold: (a) rich description of the everyday experiences, knowledge gains, and learning accumulation for a group of PCPs and nurses doing PCMH care for older adults, and (b) categories of implementation best practices (strategies, approaches, and activities) that could potentially improve PCMH care delivery for older adults. The study is innovative in several ways. First, it is driven by the general notion that there is not a "one-size-fits- all" approach to PCMH implementation. This justifies the core focus on gaining knowledge around PCP and nurse experiences implementing gold-standard PCMH principles for an important patient subgroup. Much of the extant research in this area has not yet examined the model's implementation experiences with specific patient subpopulations such as older adults. Thus, the project fills a needed empirical gap by identifying PCMH implementation best practices that are aligned closely with the unique needs and characteristics of older adult populations accessing primary care services. In addition, the study approach is novel because it applies a social psychological, agency-based perspective on the question of how to think about medical home implementation and measurement. This would be one of the first known research studies to examine PCMH implementation and measurement from the perspective of the everyday social interactions and exchanges occurring between primary care providers and their older adult patients. Its sociological orientation complements the economic and structural perspectives that researchers studying the PCMH have largely used, in this way adding new knowledge to our understanding of PCMH implementation. From an applied perspective, the rich description produced through interview data and the resulting implementation best practices that get identified will be disseminated to other organizations engaging in PCMH care. These organizations can then take this knowledge and use it to improve their own PCMH implementation processes. PUBLIC HEALTH RELEVANCE: Project Narrative This project is relevant to public health because it collects experiential data, knowledge, learning, and beliefs direct from primary care physicians and nurses that can inform our understanding of how best to implement patient-centered medical home (PCMH) care principles for older adult patients. The PCMH approach is considered imperative to improving both the quality and cost effectiveness of U.S. health care services. By exploring in-depth how provider care experiences create new knowledge and learning for understanding effective medical home implementation, further study can be conducted that situates the PCMH concept within the realities of its larger everyday organizational and patient care contexts, making it more likely to succeed long-term.