his article and the journal supplement it introduces are about the promise of primary care, the growing frustrations of not meeting that promise, and the strategies recently envisioned to try to redis-cover the lost promise. The supplement, which follows up on an earlier report,
weaves together different threads about one recent particular part of the story, the implementation and evaluation of the National Demon-stration Project (NDP) of the patient-centered medical home (PCMH).
SEVEN REPORTS THAT TOGETHER TELL A STORY
The NDP tested a new model of care and compared facilitated and self-directed approaches to implementing this model in a group-randomized clinical trial. The NDP asked what a national sample of 36 highly moti-vated family practices could accomplish in moving toward the PCMH ideal during 2 years within the current US health care payment and orga-nizational system. The project was independently evaluated using a multi-Kurt C. Stange, MD, PhD William L. Miller, MD, MA
Paul A. Nutting, MD, MSPH
Benjamin F. Crabtree, PhD
Elizabeth E. Stewart, PhD
Carlos Roberto Jaén, MD, PhD
Confl icts of interest: The authors’ funding partially
supports their time devoted to the evaluation, but
they have no fi nancial stake in the outcome. The
authors’ agreement with the funders gives them
complete independence in conducting the evaluation
and allows them to publish the fi ndings without prior
review by the funders. The authors have full access
to and control of study data. The funders had no
role in writing or submitting the manuscript.
Kurt C. Stange, MD, PhD
Case Western Reserve University
10900 Euclid Ave, LC 7136
Cleveland, OH 44106
ANNALS OF FAMILY MEDICINE
VOL. 8, SUPPLEMENT 1, 2010
CONTEXT FOR UNDERSTANDING THE NDP AND PCMH
method approach that integrated qualitative methods
to tell the NDP story from multiple perspectives and
quantitative methods to assess and compare aspects that
could be measured. Collectively, the 7 reports/articles
in this supplement, listed in Table 1, explain the pro-cess, outcomes, lessons, and implications of the NDP. The fi rst report
explains the multimethod
approach required to evaluate the NDP. The use of
both quantitative and qualitative methods in a clinical
trial in which practices were randomized to facilitated
and self-directed implementation approaches enabled
an evolving intervention to be comprehensively
assessed and understood in a changing environment.
Ongoing feedback allowed the intervention team to
adapt their approach to emerging insights.
The next report
portrays how the NDP unfolded
as seen by the independent evaluators. This article
shows how the concept of a new model of practice, the
personal medical home, changed as the TransforMED
implementation organization, the PCMH movement,
and the health care system evolved together during a
turbulent time in American health care.
The third report
examines the degree to which
the wide range of NDP model components were
implemented. This article also compares facilitated and
self-directed practices on 3 practice-level outcomes:
the proportion of the NDP model components imple-mented, the practices’ capability to make and sustain change, and an aggregate measure of the patient’s
experience with the practice.
The fourth report
brings to life the journeys expe-rienced by the facilitated and self-directed practices during the NDP. This article uses case descriptions to
explain variations in time, strategy, and resources that
enabled or limited practice development.
The fi fth report
assesses the effect of the NDP
intervention on patients and on the process of patient
care. Two complementary categories of quality of care
were assessed: patient report of multiple domains of
their experience of health care and...