Building the foundation for health system transformation: Oregon's Patient-Centered Primary Care Home program

J Public Health Manag Pract. 2015 Jan-Feb;21(1):34-41. doi: 10.1097/PHH.0000000000000083.


Objective: Health system reform is largely dependent upon the transformation of primary care in addition to the alignment of incentives that mediate the allocation of resources. The Patient-Centered Medical Home (PCMH) is a model of enhanced primary care that encourages coordination, patient-centered care, integration of public health services, and innovative methods for improving population health-all critical elements of health system reform. Because it changes the way primary care is organized and delivered, the PCMH model has been adopted as a foundational component of Oregon's health system transformation. This article presents insights drawn from an evaluation of the implementation of Oregon's Patient-Centered Primary Care Home (PCPCH) program and the adoption of the model by primary care providers.

Design: We used a mixed-methods approach consisting of 2 surveys of recognized PCPCH practices, qualitative document analysis, and key informant interviews. Evaluation research findings were triangulated with findings from PCPCH clinic site visits conducted as part of a regulatory verification process.

Results: Survey results describe a broad range of strategies and practices adopted by recognized PCPCH clinics within 6 defined core attributes: (1) access to care; (2) accountability; (3) comprehensive whole-person care; (4) continuity; (5) coordination and integration; and (6) person- and family-centered care. We also identify 4 key factors that influenced the conceptualization, development, and implementation of the PCPCH program: (1) support and motivations; (2) administrative barriers and resource constraints; (3) alignment of short- and long-term financial incentives; and (4) leadership and interpersonal relationships.

Conclusions: This evaluation provides insights into the factors that influence implementation of a primary care home program as public policy; the strategies and challenges associated with implementation of the model; and the implications of both for other states that are engaged in-or considering-similar system reform efforts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Comprehensive Health Care / methods*
  • Humans
  • Oregon
  • Organizational Innovation*
  • Patient-Centered Care / methods*
  • Primary Health Care / methods*
  • Primary Health Care / organization & administration
  • Qualitative Research
  • Quality of Health Care
  • Surveys and Questionnaires