Press Release

Embargoed Until Contact

June 30, 2011
12:01 AM EST

Sue Ducat
Director of Communications
(301) 841-9962


Smaller Practices And The Patient-Centered Medical Home: A Work In Progress


Bethesda, MD -- A new national study of small and medium-size physician practices shows that this group is not using many of the organized care processes belonging to the patient-centered medical home model of health system reform included in the Affordable Care Act of 2010. The study was released today online by Health Affairs as a Web First article and will also appear in the journal’s August issue. This is the first time national data has been collected to measure how doctors in practices with less than 20 physicians have incorporated the principles of the patient-centered medical home model into their practices. Since 88 percent of all practices in the United States have nine or fewer physicians, these findings are important.


Small And Medium-Size Physician Practices Use Few Patient-Centered Medical Home Processes
By Diane R. Rittenhouse, Lawrence P. Casalino, Stephen M. Shortell, Sean R. McClellan, Robin R. Gillies, Jeffrey A. Alexander, and Melinda L. Drum

Rittenhouse, Shortell, McClellan, and Gillies are affiliated with the University of California, Rittenhouse with UC-San Francisco and Shortell, McClellan, and Gillies with UC-Berkeley; Casalino is with the Weill Cornell Medical College in New York; Alexander is with the University of Michigan in Ann Arbor; and Drum is with the University of Chicago.

The National Study of Small and Medium-Sized Physician Practices was funded by the Robert Wood Johnson Foundation.


The authors used data from the National Study of Small and Medium-Sized Physician Practices, conducted between July 2007 and March 2009. They analyzed 1,344 of the 1,765 survey responses, excluding practices where less than 33 percent of the providers were primary care physicians. The four medical home principles they looked at included: team-based care; coordinated care facilitated by electronic health records; a focus on quality and safety; and expanding patient access to care. According to their data, practices on average earned 21.7 percent of the possible points for use of medical home processes, and solo and two-physician practices scored significantly lower. However, in the smaller practices physicians were significantly more likely to communicate with patients via e-mail and incorporate patient feedback into their practices. Conclude the authors, “it appears that major changes will be required if the patient-centered medical home is to be widely adopted.” Since small practices continue to play a major role in US health care delivery, the authors urge “health care leaders to identify and test potential strategies to accelerate reforms in these settings.” Potential strategies include facilitating change at the practice level, shared resources for smaller practices, increased financial incentives to motivate practice redesign, and preparing the next generation of health care providers to practice in new care models.


About Health Affairs

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at You can also find the journal on Facebook and Twitter and download Narrative Matters on iTunes. Address inquiries to Sue Ducat at (301) 841-9962 or