Journey toward a Patient-Centered Medical Home: Readiness for Change in Primary Care Practices

Context: Information is limited regarding the readiness of primary care prac-tices to make the transformational changes necessary to implement the patient-centered medical home (PCMH) model. Using comparative, qualitative data, we provide practical guidelines for assessing and increasing readiness for PCMH implementation. Methods: We used a comparative case study design to assess primary care practices ’ readiness for PCMH implementation in sixteen practices from twelve different physician organizations in Michigan. Two major components of orga-nizational readiness, motivation and capability, were assessed. We interviewed eight practice teams with higher PCMH scores and eight with lower PCMH scores, along with the leaders of the physician organizations of these practices, yielding sixty-six semistructured interviews. Findings: The respondents from the higher and lower PCMH scoring prac-tices reported different motivations and capabilities for pursuing PCMH. Their motivations pertained to the perceived value of PCMH, financial incentives, understanding of specific PCMH requirements, and overall commitment to change. Capabilities that were discussed included the time demands of im-plementation, the difficulty of changing patients ’ behavior, and the challenge