A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia.

OBJECTIVE

To review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms.

STUDY DESIGN

Systematic review of peer-reviewed literature.

DATA SOURCES

PubMed and Embase databases were searched in December 2012 for studies published in English between January 2007 and December 2012.

STUDY SELECTION

Studies of any type were included if they defined PCMH using the Patient-Centered Primary Care Collaborative Joint Principles, and reported data on challenges and barriers to implementation and adoption of the PCMH model.

DATA EXTRACTION

One researcher with content knowledge in the area abstracted data relating to the review objective and study design from eligible articles. A second researcher reviewed the abstracted data alongside the original article to check for accuracy and completeness.

DATA SYNTHESIS

Thematic synthesis was used to in three stages: free line-by-line coding of data; organisation of "free codes" into related areas to construct "descriptive" themes and develop "analytical" themes. The main barriers identified related to: challenges with the transformation process; difficulties associated with change management; challenges in implementing and using an electronic health record that administers principles of PCMH; challenges with funding and appropriate payment models; insufficient resources and infrastructure within practices; and inadequate measures of performance.

CONCLUSION

This systematic review documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable evidence for Australian clinicians, policymakers, and organisations approaching adoption of PCMH elements within reform initiatives in this country.