PCMH Tools & Resources

You don’t have to start from scratch when setting out build a Patient-Centered Medical Home. You can find support from a variety of useful resources on the Internet – which can connect you to organizations and practices that will share experiences with you. Here is a list organized by major topic.

Patient-Physician Partnership Resources

  • Supporting Patient Engagement in the Patient-Centered Medical Home. [Download PDF]
  • Transforming the Patient Experience. Center for Informed Medical Decisions: Four patients share their stories about how they became active participants in their medical decisions. Patient experiences include heart disease, type 2 diabetes, back pain, and early stage breast cancer. [Link to Video]
  • Patient-Physician Partnership Agreement for Diabetes. [Download PDF]]


Health Information Technology Resources:

  • Meaningful Connections: A Resource Guide for Using Health IT to Support the Patient Centered Medical Home is a white paper from the Patient-Centered Primary Care Collaborative that describes the capabilities and functionalities needed to build an information platform that supports the key elements of the PCMH. [Download PDF]
  • The FPM Toolbox from the American Academy of Family Physicians has several useful resources for evaluating health information technology, which include an Electronic Health Record (EHR) Demonstration Rating Form, an EHR Functionality List to prioritize needs, an EHR vendor rating tool, and an Electronic Medical Records Cost-Analysis Spreadsheet and Savings Calculator. [Link]
  • ACP Center for Practice Improvement and Innovation features a Health Information Technology section that provides, among other resources, toolkits for deciding on when to use electronic health records and which might be best for your practice. The ACP website to help doctors select an appropriate EHR system for their practice and accelerate the process of EHR adoption. It helps break down the process into a comprehensive 10-step project and provides consultation with an industry expert.
  • TransforMED offers HIT information and tools that include the following: Electronic Health Records, Electronic Prescribing, Disease and Population Management Software Registries, Evidence-Based Decision Support, and Patient Websites and Portals. TransforMED has partnered with Welch Allyn to develop a new web based tool.  [Link]
  • The Dollar and Sense Behind the Electronic Health Record is a personal and quick overview of the value of the EHR in a family practice.  [Download PDF]
  • How We Improved Our Practice and Our Bottom Line with a New EMR System, a practical review of the experience of one four-doctor family practice. [Link]


Evidence-based Resources

  • The Outcomes of Implementing Patient-Centered Medical Home Interventions: A Review of the Evidence on Quality, Access and Costs from Recent Prospective Evaluation Studies. This briefing documents recent evidence demonstrating the effectiveness of the PCMH model and can be downloaded from the PCPCC website.
  • Proof in Practice Pilot Guide is a compilation of the PCMH pilot and demonstration projects and their results to date. The guide provides descriptions and details of how the pilot projects are structured and what they have achieved, and also includes a review of the evidence on quality, access, and costs from recent prospective evaluation studies. [Link] 
  • The National Committee on Quality Assurance (NCQA) also recognizes the PCMH and allows practices to obtain designation as medical homes on one of three levels. This recognition may qualify physicians for extra payment and technical support from health plans. Details can be found on their website  [Link].


Organization-related Resources

  • PCPCC: Federal and State Government. [Link]
  • PCPCC: Center for Employer Engagement. [Link]


Getting Started Resources

  • Medical Home Builder from the American College of Physicians (ACP). Whether you’re interested in making incremental changes toward PCMH or a complete transition, the Medical Home Builder can help you quickly assess your practice, identify specific tools and resources based on your needs, and prepare for recognition as a Medical Home. [Link]
  • TransforMED's Patient-Centered Model, a subsidiary of the American Academy of Family Physicians, offers an online practice assessment tool and team-building tools on their website.
  • Building Your Medical Home from the American Academy of Pediatrics supports the development and/or improvement of a pediatric medical home. It also provides resources to prepare practices to apply for and meet the National Committee for Quality Assurance (NCQA) Physician Practice Connections® Patient-Centered Medical Home (PPC-PCMHTM) Recognition program. [Link]


Team Building Resources

  • The FPM Toolbox from the American Academy of Family Practice offers more than 150 practice management tools that you can download for free. Two tools relevant to team building are the Work Relationship Assessment Form and Teamwork is Crucial to New Model of Care. [Link]
  • Building the Team: Patient-Centered Primary Care Collaborative. [Link]
  • Partnering in Self-Management Support – A Toolkit for Clinicians. Institute for Healthcare Improvement. [Link] 


Family Community Resources

  • 2009 PCPCC Consumer Guide offers tips and strategies to engage and support consumers and other stakeholders in PCMH demonstrations. [Link]
  • Welcome to Your Medical Home has a  brochure and checklist for patients and families.
  • Introduction to Patient-Centered Medical Home: four-minute video. [link]
  • The National Family Caregivers Association includes a comprehensive list of agencies and organizations offering valuable information, support and assistance to family caregivers. 
  • The Community Services Locator is an online directory for finding community services for children and families. 


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