Table 4.

Phases of Practice Transformation

Pattern of Changes Implemented in Practice Transformation

Phase 1: Creating PCMH foundation  Added care coordination staff (clinical care coordinator, referral coordinator, health educator)  Created a PCMH team  Added interdisciplinary team  Added regular meetings with the PCMH team and with interdisciplinary team  Increased use of patient experience data and QI process  Added doctors (eg, family practice/internal medicine)a  Added OB-GYN specialistsa  Added a pharmacista   Added a clinical pharmacist (including telepharmacist)  Reconfigured spacea Phase 2: Realigning to support continuity of care  Assigned medical assistants to a doctor  Empanelment  Explicitly created a PCMH culturea Phase 3: Increasing access to care by adding urgent care and/or extending hours  Added urgent care  Added extended hours  Changes to EMR-–added patient portal Phase 4: Planning and managing the patient visit  Added daily huddle  Implemented training called AIDETa Optional phase: Focusing on scheduling, access, and communication of test results  Added same day slots/walk-ins  Changed practice’s process of communication of test results/laboratory results  Changes to EMR—added reporting of laboratory/radiology results  Changes to EMR—added automated appointment reminders  Changes to EMR—added e-prescribing  Changes to EMR—added referral functionality

Abbreviations: EMR, electronic medical record; PCMH, patient-centered medical home.

^aAIDET (acknowledge, introduce, duration, explain, thank you).