Problem: Although the Patient Protection and Affordable Care Act contains provisions for the financing and initiation of the PCMH model into primary care practices, many rural advocates are concerned that RHCs may not be prepared to participate in these transformation initiatives (Bolin, et al., 2011). Although research suggests that RHCs are less likely than other types of practices to have implemented health information technology (HIT) or a formal quality improvement infrastructure, no national study has specifically addressed their readiness to participate in the PCMH model. Building on and using data from our national RHC survey on meaningful use, this study will explore the capacity of RHCs to serve as PCMHs and will describe the state of quality improvement activities in RHCs.

Project Goals: This project will describe and assess: 1) the capacity of RHCs to serve as PCMHs (i.e., HIT, technical knowledge, and quality, administrative, and clinical systems); 2) the extent to which RHCs have implemented care delivery and practice management features (i.e., care management, team-based practice, patient tracking, clinical-decisions support tools, after-hours care, etc.) of the PCMH model; 3) the quality improvement infrastructure of RHCs; and 4) the technical assistance and resources needed by RHCs to implement the PCMH model.

Methods: This mixed methods study will use quantitative data from the current RHC survey to describe key characteristics indicating implementation of or readiness to implement elements of a PCMH, and qualitative data from case studies of 5-6 RHCs that are recognized PCMHs to describe the challenges they faced in implementing and sustaining the PCMH model. We will also conduct telephone interviews with key RHC experts to identify and describe any barriers to implementing the PCMH model related to CMS and state regulatory or reimbursement policies. We will analyze and report the data separately for independent and provider-based RHCs.

Anticipated Products: An article for submission to a peer reviewed journal and a policy brief. Presentation abstracts will be submitted for appropriate meetings sponsored by the National Rural Health Association, National Association of Rural Health Clinics, National Organization of State Offices of Rural Health, and other organizations.

Publications

• Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
  Policy Brief
  Maine Rural Health Research Center
  Date: 02/2015
  This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.