Objectives—Safety Net Health Centers (SNHCs), which include Federally Qualified Health Centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the Patient Centered Medical Home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs. Design—This qualitative study characterizes early PCMH adoption experiences at SNHCs.
Setting and Participants—We interviewed 98 staff,(administrators, providers, and clinical
staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH
collaborative, the Safety Net Medical Home Initiative.
Main Measures—We conducted 30-45 minute, semi-structured telephone interviews. Interview
questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition
to PCMH.
Results—Anticipated benefits for participating in the PCMH included improved staff
satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of
financial support for PCMH functions. Lessons learned included involving a range of staff,
anticipating resistance, and using data as frequent feedback.
Conclusions—SNHCs encounter unique challenges to PCMH implementation, including staff
turnover and providing care for patients with complex needs. Staff resistance and turnover may be
ameliorated through improved healthcare delivery strategies associated with the PCMH. Creating
predictable and continuous funding streams may be more fundamental challenges to PCMH
transformation