Date of Graduation

Spring 5-19-2016

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions



First Advisor

Dr. K.T. Waxman

Second Advisor

Dr. Mary Bittner


Patient-Centered Medical Home (PCMH) recognition is a process and a road map to improving quality of and access to care. Extant studies have shown that adoption of the PCMH model of care has lowered healthcare expenditure by 15-20% (Nielsen, Langner, Zema, Hacker, & Grundy, 2012). In an effort to reduce healthcare cost in the United States, private and public sectors have embraced the philosophy of PCMH by developing national programs and initiatives for primary care practices to obtain PCMH recognition. A number of payers and health plans have used PCMH recognition as a means to validate high-performing practices and reward them with increased reimbursement in exchange for this qualification (Nielsen, Olayiwola, Grundy, & Grumbach, 2014). Policymakers have invested in PCMH transformation through various PCMH initiatives, such as those of Center for Medicare and Medicaid Services (CMS) and Affordable Care Act (Nielsen et al., 2012). This paper describes the situation, gaps, and identified needs for improvement, as well as solution and evaluation of steps that a small primary care practice in San Francisco, California, has and is still undertaking to transform its practice with the aim of aligning all processes with the PCMH framework. With this recognition, it is anticipated that substantial financial savings will be obtained through increasing the preventive care rate, enhancing patient and professional satisfaction, and improving ability to generate reports on performance measures and quality metrics to meet grant requirements.

Keywords: patient-centered medical home, transformation, US healthcare, challenges, implementation, strategies, primary care, practice change