How do general practices evolve to becoming patient centred medical homes?

A process of primary care renewal is evolving across the developed world. It is increasingly recognised that high performing primary care that has a focus on prevention and management of non-communicable disease is needed to optimise care of vulnerable populations. At the same time the strain on those working in primary care has become increasingly clear. In light of the quadruple aim of enhancing patient experience, improving population health, reducing costs and improving the work life of health care providers, the concept of the patient centred medical home (PCMH) has become increasingly popular. The PCMH model embraces payment reform, reorganisation of the practice setting, improvements in data and realignment of the roles and responsibilities of the primary care practice workforce [2]. Early evaluations suggest that, while the PCMH can increase screening and decrease the requirements for specialist care, its outcomes are closely tied with the context and with the way the model is implemented. There is increasing interest in the PCMH model in Australia. The Royal Australian College of General Practitioners has recognised the potential for the PCMH as a mechanism to promote sustainable patient-centred, integrated, high-quality and accessible care [3]. In recent years a range of Australian government bodies have advocated for a transition to medical home model of care. The question remains as to how these transitions can occur. Large scale transformation in the model of delivery for Australian primary care is likely to take some time. However, practices across the country are, by themselves, beginning to explore novel ways of embracing the principles of the PCMH. It has become clear that there is much to be learned from real-world practice transformation. Unfortunately, most of the literature focuses on what “primary care should do”, rather than "what primary care is already doing well". Furthermore, few studies have allowed researchers to get “behind the closed door” of the primary care practice and to see how change is really enacted. Direct non participant observation is one way to get to this deeper understanding of how practices work. Professor Russell and his team within Monash University’s Department of General Practice have used these approaches to understand how primary care practices do their work, and how they respond to change - recent work has explored the ways in which they have negotiated COVID 19, and have been conducted in GP Superclinics, traditional practices, community heath centres and corporates. This proposed study aims to use this approach to explore the organisational routines of innovative, high performing general practices, with a focus on identifying potential traits that may aid transition to a PCMH model. Prior examples of work 1. Russell G, Lane R, Neil J, et al. At the edge of chaos: a prospective multiple case study in Australian general practices adapting to COVID-19. BMJ Open. 2023;13(1):e064266. 2. Russell G, Advocat J, Lane R, et al. How do general practices respond to a pandemic? Protocol for a prospective qualitative study of six Australian practices. BMJ Open. 2021;11(9):e046086. 3. Russell G, Lane R, Parker S, et al. Preventive Evidence into Practice: what factors matter in a facilitation intervention to prevent vascular disease in family practice? BMC Fam Pract. 2019;20(1):113. 4. McDonald J, Ward B, Lane R, et al. How are co-located primary health care centres integrating care for people with chronic conditions? International Journal of Integrated Care. 2017;17(3). 5. Lane R, Russell G, Bardoel EA, et al. When colocation is not enough: a case study of General Practitioner Super Clinics in Australia. Aust J Prim Health. 2016.