The Patient-centered Medical Home Movement — Promise and Peril for Family Medicine

John C. Rogers, MD, MPH, MEd


J Am Board Fam Med. 2008;21(5):370-374. 

In This Article


It helps me to divide the Joint Principles of the Patient-Centered Medical Home[8] into 2 categories: (1) the type of care we provide to patients and (2) the practice infrastructure that supports our work.[3] The "care principles" are the personal physician, physician-directed medical practice, whole person orientation, and that care is coordinated and/or integrated. The "infrastructure principles" are that care is coordinated and/or integrated, quality and safety, enhanced access, and payment for added value. Note that coordination and integration of care is a care principle in that we strive to do this for individual patients, but it is an infrastructure principle when it requires registries, information technology, and health information exchange.

We have been striving and succeeding for decades to practice in ways that are consistent with the care principles. We also have a long history of teaching students and residents about this type of care with accreditation standards that enforce achievement of the principles in resident training. We also have considerable scholarship and research documenting our provision of this care and its value to patients and community health, as illustrated in part by Rosenthal's article in this issue of the Journal of the American Board of Family Medicine.[9]

Our strength with the infrastructure principles is our commitment to evidence-based clinical guidelines, quality improvement, and information technology and our efforts to apply these to our routine medical care. We have well-developed approaches for bringing the best information to the point of care and have growing experience with enhanced access through open scheduling, expanded hours, and electronic communication.

There is also strength in understanding the process of change in clinical practices and how to facilitate that process. We have a solid scholarship base in this area and practical experience with the TransforMED and P[4] projects.[10] Strengths in the care and infrastructure principles and the change process are a foundation for further progress.


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