Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 6/2010

Open Access 01-06-2010 | Original Article

Defining and Measuring the Patient-Centered Medical Home

Authors: Kurt C. Stange, MD, PhD, Paul A. Nutting, MD, MSPH, William L. Miller, MD, MA, Carlos R. Jaén, MD, PhD, Benjamin F. Crabtree, PhD, Susan A. Flocke, PhD, James M. Gill, MD, MPH

Published in: Journal of General Internal Medicine | Issue 6/2010

Login to get access

Abstract

The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices’ internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare.
The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to healthcare systems not based on primary care.
The needed practice organizational and health care system change aspects of the PCMH are still evolving in highly related ways. The PCMH will continue to evolve as evidence comes in from hundreds of demonstrations and experiments ongoing around the country, and as the local and larger healthcare systems change.
Measuring the PCMH involves the following:
  • Giving primacy to the core tenets of primary care
  • Assessing practice and system changes that are hypothesized to provide added value
  • Assessing development of practices’ core processes and adaptive reserve
  • Assessing integration with more functional healthcare system and community resources
  • Evaluating the potential for unintended negative consequences from valuing the more easily measured instrumental features of the PCMH over the fundamental relationship and whole system aspects
  • Recognizing that since a fundamental benefit of primary care is its adaptability to diverse people, populations and systems, functional PCMHs will look different in different settings.
Efforts to transform practice to patient-centered medical homes must recognize, assess and value the fundamental features of primary care that provide personalized, equitable health care and foster individual and population health.
Appendix
Available only for authorised users
Literature
1.
Patient-Centered Medical Home Collaborative. The Patient-Centered Medical Home Collaborative
2.
Rosenthal TC. The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med. 2008;21(5):427–40.PubMedCrossRef
3.
Rogers JC. The patient-centered medical home movement–promise and peril for family medicine. J Am Board Fam Med. 2008;21(5):370–4.PubMedCrossRef
4.
Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform? Jama. 2009;301(19):2038–40.PubMedCrossRef
5.
6.
Bodenheimer T. The future of primary care: transforming practice. N Engl J Med. 2008;359(20):2086–9.PubMedCrossRef
7.
Larson EB, Fihn SD, Kirk LM, et al. The future of general internal medicine. Report and recommendations from the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine. J Gen Intern Med. 2004;19(1):69–77.PubMedCrossRef
8.
Sandy LG, Schroeder SA. Primary care in a new era: disillusion and dissolution? Ann Intern Med. 2003;138(3):262–7.PubMed
9.
Sandy LG, Bodenheimer T, Pawlson LG, Starfield B. The political economy of U.S. primary care. Health Aff (Millwood). 2009;28(4):1136–45.CrossRef
10.
11.
Rittenhouse DR, Casalino LP, Gillies RR, Shortell SM, Lau B. Measuring the medical home infrastructure in large medical groups. Health Aff (Millwood). 2008;27(5):1246–58.CrossRef
12.
Friedberg MW, Safran DG, Coltin KL, Dresser M, Schneider EC. Readiness for the patient-centered medical home: structural capabilities of Massachusetts primary care practices. J Gen Intern Med. 2009;24(2):162–9.PubMedCrossRef
13.
14.
Patient Centered Primary Care Collaborative. 2009 PCPP Pilot Guide: Proof in Practice. A compilation of patient centered medical home pilot and demonstration projects. Washington, D.C.: National Committee for Quality Assurance; 2009:90.
15.
Donaldson MS, Yordy KD, Lohr KN, Vanselow NA, eds. Primary care America's health in a new era. Washington D.C.: National Academy Press; 1996.
16.
Starfield B, Shi LY, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.PubMedCrossRef
17.
18.
19.
Ferrer RL, Hambidge SJ, Maly RC. The essential role of generalists in health care systems. Ann Intern Med. 2005;142(8):691–9.PubMed
20.
Casalino LP. The unintended consequences of measuring quality on the quality of medical care. N Engl J Med. 1999;341(15):1147–50.PubMedCrossRef
21.
Weyer SM, Bobiak S, Stange KC. Possible unintended consequences of a focus on performance: insights over time from the research association of practices network. Qual Manag Health Care. 2008;17(1):47–52.PubMed
22.
Roland M. Pay-for-performance: too much of a good thing? A conversation with Martin Roland. Interview by Robert Galvin. Health Aff (Millwood). 2006;25(5):w412–9.CrossRef
23.
Werner RM, Asch DA. The unintended consequences of publicly reporting quality information. Jama. 2005;293(10):1239–44.PubMedCrossRef
24.
Campbell SM, McDonald R, Lester H. The experience of pay for performance in english family practice: a qualitative study. Ann Fam Med. 2008;6(3):228–34.PubMedCrossRef
25.
Werner RM, McNutt R. A new strategy to improve quality: rewarding actions rather than measures. Jama. 2009;301(13):1375–77.PubMedCrossRef
26.
Nutting PA, Miller WL, Crabtree BF, Jaén CR, Stewart EE, Stange KC. Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home. Ann Fam Med. 2009;254–60.
27.
The medical home. Pediatrics. 2003;110(1 Pt 1):184-186.
28.
Sia C, Tonniges TF, Osterhus E, Taba S. History of the medical home concept. Pediatrics. 2004;113(5 Suppl):1473–8.PubMed
29.
Martin JC, Avant RF, Bowman MA, et al. The future of family medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2(Suppl 1):S3–32.PubMed
30.
American College of Physicians (ACP). The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care; 2006.
31.
Task Force 1 Writing Group, Green A, Graham R, et al. Task Force 1. Report of the task force on patient expectations, core values, reintegration, and the new model of family medicine. Ann Fam Med. 2004;2(Suppl 1):S33–50.
32.
Institute of Medicine: Committee on Quality of Health Care in America. Crossing the Quality Chasm: A new health system for the 21st century. Washington DC: National Academy Press; 2001.
33.
Zweifler J. The missing link: improving quality with a chronic disease management intervention for the primary care office. Ann Fam Med. 2007;5(5):453–6.PubMedCrossRef
34.
35.
Robert Graham Center. The Patient Centered Medical Home: History, seven core features, evidence and transformational change. Washington, DC; 2007.
36.
Starfield B. Primary care: balancing health needs, services, and technology. New York: Oxford University Press; 1998.
37.
McWhinney IR, Freeman T. Textbook of family medicine. 3rd ed. New York: Oxford University Press; 2009.
38.
Stange KC, Jaén CR, Flocke SA, Miller WL, Crabtree BF, Zyzanski SJ. The value of a family physician. J Fam Pract. 1998;46(5):363–8.PubMed
39.
Reid RJ, Fishman PA, Yu O, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care. 2009;15(9):e71–87.PubMed
40.
TransforMED. The TransforMED Patient-Centered Model.
41.
Fortney JC, Pyne JM, Edlund MJ, et al. A randomized trial of telemedicine-based collaborative care for depression. J Gen Intern Med. 2007;22(8):1086–93.PubMedCrossRef
42.
Peek CJ. Integrating care for persons, not only diseases. J Clin Psychol Med Settings. 2009;16(1):13–20.PubMedCrossRef
43.
Harkness EF, Bower PJ. On-site mental health workers delivering psychological therapy and psychosocial interventions to patients in primary care: effects on the professional practice of primary care providers. Cochrane Database Syst Rev. 2009;1:CD000532.PubMed
44.
Nutting PA, Gallagher K, Riley K, et al. Care management for depression in primary care practice: findings from the RESPECT-Depression trial. Ann Fam Med. 2008;6(1):30–7.PubMedCrossRef
45.
Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005;3(3):223–8.PubMedCrossRef
46.
Noel PH, Parchman ML, Williams JW Jr, et al. The challenges of multimorbidity from the patient perspective. J Gen Intern Med. 2007;22(Suppl 3):419–24.PubMedCrossRef
47.
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357–63.PubMedCrossRef
48.
Domino ME, Humble C, Lawrence WW Jr, Wegner S. Enhancing the medical homes model for children with asthma. Med Care. 2009;47(11):1113–20.PubMedCrossRef
49.
Nutting PA, Dickinson WP, Dickinson LM, et al. Use of chronic care model elements is associated with higher-quality care for diabetes. Ann Fam Med. 2007;5(1):14–20.PubMedCrossRef
50.
Dorr DA, Wilcox A, Burns L, Brunker CP, Narus SP, Clayton PD. Implementing a multidisease chronic care model in primary care using people and technology. Dis Manag. 2006;9(1):1–15.PubMedCrossRef
51.
Wagner EH, Glasgow RE, Davis C, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27(2):63–80.PubMed
52.
Barr VJ, Robinson S, Marin-Link B, et al. The expanded Chronic Care Model: an integration of concepts and strategies from population health promotion and the Chronic Care Model. Hosp Q. 2003;7(1):73–82.PubMed
53.
Wagner EH, Bennett SM, Austin BT, Greene SM, Schaefer JK, Vonkorff M. Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med. 2005;11(Suppl 1):S7–15.PubMed
54.
55.
Fisher ES. Building a medical neighborhood for the medical home. N Engl J Med. 2008;359(12):1202–5.PubMedCrossRef
56.
Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood). 2008;27(5):1235–45.CrossRef
57.
DuBard CA, Cockerham J. Community Care of North Carolina and the medical home approach to chronic kidney disease. N C Med J. 2008;69(3):229–32.PubMed
58.
Beach MC, Inui T. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21(Suppl 1):S3–8.PubMedCrossRef
59.
Cheraghi-Sohi S, Hole AR, Mead N, et al. What patients want from primary care consultations: a discrete choice experiment to identify patients' priorities. Ann Fam Med. 2008;6(2):107–15.PubMedCrossRef
60.
Berwick DM. What 'Patient-Centered' Should Mean: Confessions Of An Extremist. Health Aff (Millwood). May 19 2009.
61.
Berenson RA, Hammons T, Gans DN, et al. A house is not a home: keeping patients at the center of practice redesign. Health Aff (Millwood). 2008;27(5):1219–30.CrossRef
62.
Solberg LI, Hroscikoski MC, Sperl-Hillen JM, Harper PG, Crabtree BF. Transforming medical care: case study of an exemplary, small medical group. Ann Fam Med. 2006;4(2):109–16.PubMedCrossRef
63.
Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries' quality of care. Health Aff (Millwood). 2004;Suppl Web Exclusives:W184–97.
64.
Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. Jama. 1992;267(12):1624–30.PubMedCrossRef
65.
Lewin S, Lavis JN, Oxman AD, et al. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet. 2008;372(9642):928–39.PubMedCrossRef
66.
Starfield B. Primary care and equity in health: The importantce to effectiveness and equity of responsiveness to people's needs. Humanity and Society. 2009;(in press).
67.
Rohde J, Cousens S, Chopra M. 30 years after Alma-Ata: has primary health care worked in countries? Lancet. 2008;372(9642):950–61.PubMedCrossRef
68.
Ferrer RL. Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status. Ann Fam Med. 2007;5(6):492–502.PubMedCrossRef
69.
Beal AC, Doty MM, Hernandez SE, Shea KK, Davis K. Closing the Divide: How Medical Homes Promote Equity in Health Care: Results From The Commonwealth Fund 2006 Health Care Quality Survey. 2007;62.
70.
Starfield B, Shi L, Grover A, Macinko J. The effects of specialist supply on populations' health: assessing the evidence. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5-97-W95-107.
71.
Davidoff F. Heterogeneity is not always noise: lessons from improvement. Jama. 2009;302(23):2580–6.PubMedCrossRef
72.
Meads G. Primary care in the twenty-first century. Seattle: Radcliffe; 2006.
73.
Stewart EE, Nutting PA, Crabtree BF, Stange KC, Miller WL, Jaén CR. Implementing the Patient-Centered Medical Home: observation and description of the National Demonstration Project. Ann Fam Med. 2010;8.
74.
Friedberg MW, Lai DJ, Hussey PS, Schneider EC. A guide to the medical home as a practice-level intervention. Am J Manag Care. 2009;15:S291–9.PubMed
75.
Stange KC, Miller WL, Nutting PA, Crabtree BF, Stewart EE, Jaén CR. Context for understanding the first National Demonstration Project and the Patient-Centered Medical Home. Ann Fam Med. 2010;8.
76.
Institute of Medicine. Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington: The National Academies Press; 2003.
77.
Berwick DM. A user's manual for th IOM's 'Quality Chasm' report. Health Aff (Millwood). 2002;21(3):80–90.CrossRef
78.
79.
Schouten LM, Hulscher ME, van Everdingen JJ, Huijsman R, Grol RP. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ. 2008;336(7659):1491–4.PubMedCrossRef
80.
81.
Mitka M. Large group practices lag in adopting patient-centered "medical home" model. Jama. 2008;300(16):1875.PubMedCrossRef
82.
Goldberg DG, Kuzel AJ. Elements of the patient-centered medical home in family practices in virginia. Ann Fam Med. 2009;7(4):301–8.PubMedCrossRef
83.
Mambu J. Re: the patient-centered medical home movement--promise and peril for family medicine. J Am Board Fam Med. 2009;22(1):93–4. Author reply 94.PubMedCrossRef
84.
Nutting PA, Crabtree BF, Miller WL, Stewart EE, Stange KC, Jaén CR. The journey to the Patient-Centered Medical Home: a qualitative analysis of the experiences of practices in the National Demonstration Project. Ann Fam Med 2010;8 (supplement):(forthcoming).
85.
Miller WL, Crabtree BF, Nutting PA, Stange KC, Jaén CR. Primary care practice development: A relationship-centered approach. Ann Fam Med. 2010;8 (supplement)(2):(forthcoming).
86.
De Maeseneer J, van Weel C, Egilman D, Mfenyana K, Kaufman A, Sewankambo N. Strengthening primary care: addressing the disparity between vertical and horizontal investment. Br J Gen Pract. 2008;58(546):3–4.PubMedCrossRef
87.
Thomas P, Meads G, Moustafa A, Nazareth I, Stange KC. Combined vertical and horizontal integration of health care - a goal of practice based commissioning. Quality Primary Care. 2008;16(6):425–32.
88.
89.
Davis K. Slowing the growth of health care costs--learning from international experience. N Engl J Med. 2008;359(17):1751–5.PubMedCrossRef
90.
91.
Davis K, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20(10):953–7.PubMedCrossRef
92.
93.
Spann SJ. Report on financing the new model of family medicine. Ann Fam Med. 2004;2(Suppl 3):S1–21.PubMedCrossRef
94.
Goroll AH, Berenson RA, Schoenbaum SC, Gardner LB. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. J Gen Intern Med. 2007;22(3):410–5.PubMedCrossRef
95.
Goroll AH. The future of primary care: reforming physician payment. N Engl J Med. 2008;359(20):2087–90.PubMedCrossRef
96.
Berenson RA, Rich EC. How to buy a medical home: or Let a thousand options bloom? How about five? Patient-Centered Medical Home: Setting a Policy Agenda; 2009.
97.
Larson EB. Group Health Cooperative--one coverage-and-delivery model for accountable care. N Engl J Med. 2009;361(17):1620–2.PubMedCrossRef
98.
99.
100.
101.
Starfield B. The medical home index applies primarily to children with special health care needs. Ambul Pediatr. 2004;4(2):192. author reply 192-193.PubMedCrossRef
102.
DeVoe JE, Wallace LS, Pandhi N, Solotaroff R, Fryer GE Jr. Comprehending care in a medical home: a usual source of care and patient perceptions about healthcare communication. J Am Board Fam Med. 2008;21(5):441–50.PubMedCrossRef
103.
Daaleman TP. The medical home: locus of physician formation. J Am Board Fam Med. 2008;21(5):451–7.PubMedCrossRef
104.
Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. Toward higher-performance health systems: adults' health care experiences in seven countries. Health Aff (Millwood). 2007;26(6):w717–34.CrossRef
105.
106.
Medical home concept still fuzzy. Dis Manag Advis. 2008;14(2):5.
107.
Kirschner N, Barr MS. Specialists/Subspecialists and the Patient-Centered Medical Home. Chest. 2009;8.
108.
Gottlieb LM. Learning from Alma Ata: the medical home and comprehensive primary health care. J Am Board Fam Med. 2009;22(3):242–6.PubMedCrossRef
109.
Green L. The patient-centered medical home: a discussion at NAPCRG 2008. Ann Fam Med. 2009;7(2):183–4.PubMedCrossRef
110.
Pawlson LG, Bagley B, Barr M, Sevilla X, Torda P, Scholle S. Patient-Centered Medical Home: From Vision to Reality; 2007.
111.
Practitioners AAoN. Nurse practitioners: Promoting access to coordinated primary care.
112.
113.
Sugarman J. Medical home digest. New York: Commonwealth Fund; 2009.
114.
Patient-centered primary care collaborative. The patient-centered primary care collaborative.
115.
Loxterkamp D, Kazal LA Jr. Changing horses midstream: the promise and prudence of practice redesign. Ann Fam Med. 2008;6(2):167–70.PubMedCrossRef
116.
Nutting PA, Crabtree BF, Stewart EE, et al. Implementing the National Demonstration Project model of the Patient-Centered Medical Home. Ann Fam Med. 2010;8 (supplement): (forthcoming).
117.
Crabtree BF, Nutting PA, Miller WL, Stange KC, Stewart EE, Jaén CR. After the National Demonstration Project: implications and recommendations. Ann Fam Med. 2010;8 (supplement):(forthcoming).
118.
Jaén CR, Crabtree BF, Palmer R, et al. Methods for evaluating practice change towards a Patient-Centered Medical Home. Ann Fam Med. 2010;8 (supplement):(forthcoming).
119.
Jaén CR, Ferrer RL, Miller WL, et al. Patient outcomes at 26 months in the patient-centered medical home national demonstration project. Ann Fam Med. 2010;8 (supplement):(forthcoming).
120.
Wensing M, Van den Hombergh P, Van Doremalen J, Grol R, Szecsenyi J. General practitioners' workload associated to practice size rather than chronic care organisation. Health Policy. 2009;89(1):124–9.PubMedCrossRef
121.
Crabtree BF, Miller WL, McDaniel RR, Stange KC, Nutting PA, Jaén CR. A survivor’s guide for primary care physicians. J Fam Pract. 2009 Aug. 58(8):E1–E2.
122.
Goroll AH, Simon SR, Tripathi M, Ascenzo C, Bates DW. Community-wide implementation of health information technology: the Massachusetts eHealth Collaborative experience. J Am Med Inform Assoc. 2009;16(1):132–9.PubMedCrossRef
123.
Scherger JE. Future vision: is family medicine ready for patient-directed care? Fam Med. 2009;41(4):285–8.PubMed
124.
Kuzel AJ, Skoch EM. Achieving a patient-centered medical home as determined by the NCQA–at what cost, and to what purpose? Ann Fam Med. 2009;7(1):85–6.PubMedCrossRef
125.
Rittenhouse DR, Shortell SM, Fisher ES. Primary Care and Accountable Care -- Two Essential Elements of Delivery-System Reform. N Engl J Med. 2009.
126.
127.
128.
Loxterkamp D. Benefits of continuity of care. Fam Med. 2009;41(5):312.PubMed
129.
Chokshi DA. Ensuring progress in primary care--what can health care reform realistically accomplish? N Engl J Med. 2009;361(20):e43.PubMedCrossRef
130.
131.
Stange KC, Miller WL, Crabtree BF, O'Connor PJ, Zyzanski SJ. Multimethod research: approaches for integrating qualitative and quantitative methods. J Gen Intern Med. 1994;9(5):278–82.PubMedCrossRef
132.
Borkan JM. Mixed methods studies: a foundation for primary care research. Ann Fam Med. 2004;2(1):4–6.PubMedCrossRef
133.
Creswell JW, Fetters MD, Ivankova NV. Designing a mixed methods study in primary care. Ann Fam Med. 2004;2(1):7–12.PubMedCrossRef
134.
Tashakkori A, Teddlie C, eds. Handbook of mixed methods in the behavioral and social sciences. Thousand Oaks: Sage Publications; 2003.
135.
Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches. 2nd ed. Thousand Oaks: Sage Publications; 2003.
136.
Stange KC, Miller WL, McWhinney I. Developing the knowledge base of family practice. Fam Med. 2001;33(4):286–97.PubMed
137.
Stange KC, Crabtree BF, Miller WL. Publishing multimethod research. Ann Fam Med. 2006;4(4):292–4.PubMedCrossRef
138.
Stange KC, Zyzanski SJ. Integrating qualitative and quantitative research methods. Fam Med. 1989;21(6):448–51.PubMed
139.
Shi L, Macinko J, Starfield B, et al. Primary care, infant mortality, and low birth weight in the states of the USA. J Epidemiol Community Health. 2004;58(5):374–80.PubMedCrossRef
140.
Shi L, Macinko J, Starfield B, Politzer R, Wulu J, Xu J. Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties: a comparison between urban and non-urban areas. Public Health. 2005;119(8):699–710.PubMedCrossRef
141.
Shi L, Macinko J, Starfield B, Politzer R, Xu J. Primary care, race, and mortality in US states. Soc Sci Med. 2005;61(1):65–75.PubMedCrossRef
142.
Shi L, Macinko J, Starfield B, Politzer R, Wulu J, Xu J. Primary care, social inequalities, and all-cause, heart disease, and cancer mortality in US counties, 1990. Am J Public Health. 2005;95(4):674–80.PubMedCrossRef
143.
Nutting PA, Crabtree BF, Miller WL, Stange KC, Jaén CR, Stewart EE. Primary care redesign: further lessons from the national demonstration project. Health Aff (Millwood). 2010:(in press)
144.
McGlynn EA. Intended and unintended consequences: what should we really worry about? Med Care. 2007;45(1):3–5.PubMedCrossRef
145.
Ganz DA, Wenger NS, Roth CP, et al. The effect of a quality improvement initiative on the quality of other aspects of health care: the law of unintended consequences? Med Care. 2007;45(1):8–18.PubMedCrossRef
146.
Thomas P. Integrating primary health care: leading, managing, facilitating. Oxford: Radcliffe Publishing; 2006.
147.
Heath I, Rubenstein A, Stange KC, van Driel M. Quality in primary health care: a multidimensional approach to complexity. BMJ. 2009;338:b1242.PubMedCrossRef
148.
Sturmberg JP. The foundations of primary care. Oxford: Radcliffe Publishing; 2007.
149.
Stange KC. The paradox of the parts and the whole in understanding and improving general practice. Int J Qual Health Care. 2002;14(4):267–8.PubMedCrossRef
150.
Miller WL, Crabtree BF, McDaniel R, Stange KC. Understanding change in primary care practice using complexity theory. J Fam Pract. 1998;46(5):369–76.PubMed
151.
McDaniel R, Driebe DJ. Complexity science and health care management. In: Blair JD, Myron DG, Savage GT, eds. Advances in health care management, vol. 2. Stamford: JAI Press; 2000:11–36.
152.
Miller WL, McDaniel RR Jr, Crabtree BF, Stange KC. Practice jazz: Understanding variation in family practices using complexity science. J Fam Pract. 2001;50(10):872–8.PubMed
153.
Plsek PE, Greenhalgh T. Complexity science: the challenge of complexity in health care. BMJ. 2001;323(7313):625–8.PubMedCrossRef
154.
Crabtree BF. Primary care practices are full of surprises. Health Care Manage Rev. 2003;28(3):279–83. Discussion 289-290.PubMed
155.
Litaker D, Tomolo A, Liberatore V, Stange KC, Aron DC. Using complexity theory to build interventions that improve health care delivery in primary care. J Gen Intern Med. 2006;21(Suppl 2):S30–4.PubMedCrossRef
156.
Sweeney K. Complexity in primary care. Oxon: Radcliffe Publishing Ltd; 2006.
157.
Kernick D. Complexity and Healthcare Organization: a view from the street. San Francisco: Radcliffe Medical Press; 2004.
158.
159.
Rittenhouse DR, Thom DH, Schmittdiel JA. Developing a policy-relevant research agenda for the PCMH: A focus on outcomes. Patient-Centered Medical Home: Setting a Policy Agenda. Washington, DC; 2009.
160.
NCQA. Physician Practice Connections® - Patient-Centered Medical HomeTM; 2008.
161.
Solberg LI, Scholle SH, Asche SE, et al. Practice systems for chronic care: frequency and dependence on an electronic medical record. Am J Manag Care. 2005;11(12):789–96.PubMed
162.
Solberg LI, Asche SE, Pawlson LG, Scholle SH, Shih SC. Practice systems are associated with high-quality care for diabetes. Am J Manag Care. 2008;14(2):85–92.PubMed
163.
Scholle SH, Pawlson LG, Solberg LI, et al. Measuring practice systems for chronic illness care: accuracy of self-reports from clinical personnel. Jt Comm J Qual Patient Saf. 2008;34(7):407–16.PubMed
164.
Gilmer TP, O'Connor PJ, Rush WA, et al. Impact of office systems and improvement strategies on costs of care for adults with diabetes. Diabetes Care. 2006;29(6):1242–8.PubMedCrossRef
165.
Flopttemesch TJ, Scholle SH, O'Connor PJ, Solberg LI, Asche SE, Pawlson G. Association between practice systems and healthcare utilization for diabetes. Diabetes Care. 2009;(in press).
166.
O'Malley AS, Peikes D, Ginsburg PB. Qualifying a Physician Practice as a Medical Home Policy Perspective: Insights into Health Policy Issues; No. 1 December, 2008.
167.
Poplin C. No direction home: a primary care physician questions the medical home model. Health Affairs Blog; 2009.
168.
NCQA. Planned Evolution of PPC-PCMH Requirements; 2009.
169.
Safran DG, Kosinsk Mi, Tarlov AR, et al. The primary care assessment survey: tests of data quality and measurement performance. Med Care. 1998;36(5):728–39.PubMedCrossRef
170.
Safran DG, Karp M, Coltin K, et al. Measuring patients' experiences with individual primary care physicians. Results of a statewide demonstration project. J Gen Intern Med. 2006;21(1):13–21.PubMedCrossRef
171.
Cassady CE, Starfield B, Hurtado MP, Berk RA, Nanda JP, Friedenberg LA. Measuring consumer experiences with primary care. Pediatrics. 2000;105(4 Pt 2):998–1003.PubMed
172.
Shi L, Starfield B, Xu J. Validating the adult primary care assessment tool. J Fam Pract. 2001;50(2):161W–175W.
173.
Flocke SA. Measuring attributes of primary care: development of a new instrument. J Fam Pract. 1997;45(1):64–74.PubMed
174.
Flocke SA. Primary care instrument. J Fam Pract. 1998;46(1):12.
175.
Flocke SA, Miller WL, Crabtree BF. Relationships between physician practice style, patient satisfaction, and attributes of primary care. J Fam Pract. 2002;51(10):835–40.PubMed
176.
Agency for Healthcare Research and Quality. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) program: Surveys and Tools to Advance Patient-Centered Care
177.
Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002;37(3):791–820.PubMedCrossRef
178.
Von Korff M, Glasgow RE, Sharpe M. Organising care for chronic illness. BMJ. 2002;325(7355):92–4.CrossRef
179.
Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–44.PubMedCrossRef
180.
Cooley WC, McAllister JW, Sherrieb K, Clark RE. The Medical Home Index: development and validation of a new practice-level measure of implementation of the Medical Home model. Ambul Pediatr. 2003;3(4):173–80.PubMedCrossRef
181.
Howie JG, Heaney DJ, Maxwell M, Walker JJ. A comparison of a patient enablement instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Fam Pract. 1998;15(2):165–71.PubMedCrossRef
182.
Howie JG, Heaney DJ, Maxwell M, Walker JJ, Freeman GK, Rai H. Quality at general practice consultations: cross sectional survey. BMJ. 1999;319(7212):738–43.PubMed
183.
Howie JG, Heaney DJ, Maxwell M. Measuring quality in general practice. Pilot study of a needs, process and outcome measure. Occas Pap R Coll Gen Pract. 1997;75:i–xii. 1-32.PubMed
184.
Mercer SW, Maxwell M, Heaney D, Watt GC. The development and preliminary validation of the consultation and relational empathy (CARE) measure: an empathy-based consultation process measure. Fam Pract. 2004;21(6):699–705.PubMedCrossRef
185.
Heaney DJ, Walker JJ, Howie JG, et al. The development of a routine NHS data-based index of performance in general practice (NHSPPI). Fam Pract. 2002;19(1):77–84.PubMedCrossRef
186.
Mercer SW, Howie JG. CQI-2–a new measure of holistic interpersonal care in primary care consultations. Br J Gen Pract. 2006;56(525):262–8.PubMed
187.
Howie JG, Heaney D, Maxwell M. Quality, core values and the general practice consultation: issues of definition, measurement and delivery. Fam Pract. 2004;21(4):458–68.PubMedCrossRef
188.
Sequist TD, Schneider EC, Anastario M, et al. Quality monitoring of physicians: linking patients' experiences of care to clinical quality and outcomes. J Gen Intern Med. 2008;23(11):1784–90.PubMedCrossRef
189.
Starfield B. Primary care: concept, evaluation, and policy. New York, NY: Oxford University Press; 1992.
190.
Lévesque J-F, Haggerty J, Burge F, et al. Canadian experts' views on the importance of attributes within different healthcare oganizational models. Healthcare Policy. 2010:special supplement, in press.
191.
Lévesque J-F, Haggerty J, Beninguisse G, et al. Mapping the coverage of attributes in validated instruments that evaluate primary healthcare from the consumer perspective. Healthcare Policy. 2010:special supplement, in press.
192.
Haggerty J, Bouharaoui F, Santor D. Differential item functioning in primary healthcare organizational evaluation instruments by French/English version, educational level and urban/rural location. Healthcare Policy. 2010:special supplement, in press.
193.
Haggerty J, Santor D, Lawson B, Beaulieu C, Fournier M, Burge F. What patients tell us about primary healthcare evaluation instruments: response formats, bad questions and missing pieces. Healthcare Policy. 2010:special supplement, in press.
194.
Haggerty J, Lévesque J-F, Santor D, et al. Measuring accessibility from the consumer perspective: comparison of primary healthcare evaluation instruments. Healthcare Policy. 2010:special supplement, in press.
195.
Haggerty J, Beaulieu M-D, Pineault R, et al. Measuring comprehensiveness of care from the consumer perspective: comparison of primary healthcare evaluation instruments. Healthcare Policy. 2010:special supplement, in press.
196.
Burge F, Haggerty J, Beaulieu M-D, Lévesque J-F, Beaulieu C, Santor D. Measuring relational continuity from the consumer perspective: comparison of primary healthcare evaluation instruments. Healthcare Policy. 2010:special supplement, in press.
197.
Haggerty J, Burge F, Pineault R, et al. Measuring management continuity from the consumer perspective: comparison of primary healthcare evaluation instruments. Healthcare Policy. 2010:special supplement, in press.
198.
Beaulieu M-D, Haggerty J, Beaulieu C, et al. Measuring interpersonal communication from the consumer perspective: comparison of primary healthcare evaluation instruments. Healthcare Policy. 2010:special supplement, in press.
199.
World Health Organization. Commission on Social Determinants of Health - Final Report; 2008.
200.
Epstein RM, Franks P, Fiscella K, et al. Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues. Soc Sci Med. 2005;61(7):1516–28.PubMedCrossRef
201.
Shields CG, Franks P, Fiscella K, Meldrum S, Epstein RM. Rochester Participatory Decision-Making Scale (RPAD): reliability and validity. Ann Fam Med. Sep-Oct. 2005;3(5):436–42.CrossRef
202.
Bobiak SN, Zyzanski SJ, Ruhe MC, et al. Measuring practice capacity for change – A tool for guiding quality improvement in primary care settings. Quality Management in Health Care. 2009;in press.
203.
Ohman-Strickland PA, John Orzano A, Nutting PA, et al. Measuring organizational attributes of primary care practices: development of a new instrument. Health Serv Res. 2007;42(3 Pt 1):1257–73.PubMedCrossRef
204.
Tallia AF, Lanham HJ, McDaniel RR Jr, Crabtree BF. 7 characteristics of successful work relationships. Fam Pract Manag. 2006;13(1):47–50.PubMed
205.
Fortin M, Bravo G, Hudon C, Lapointe L, Dubois MF, Almirall J. Psychological distress and multimorbidity in primary care. Ann Fam Med. 2006;4(5):417–22.PubMedCrossRef
206.
Fortin M, Bravo G, Hudon C, et al. Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res. 2006;15(1):83–91.PubMedCrossRef
207.
Fortin M, Dubois MF, Hudon C, Soubhi H, Almirall J. Multimorbidity and quality of life: a closer look. Health Qual Life Outcomes. 2007;5(1):52.PubMedCrossRef
208.
Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M. Multimorbidity's many challenges. Time to focus on the needs of this vulnerable and growing population. BMJ. 2007;334(7602):1016–7.PubMedCrossRef
209.
Starfield B, Lemke KW, Herbert R, Pavlovich WD, Anderson G. Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med. 2005;3(3):215–22.PubMedCrossRef
210.
Starfield B. Threads and yarns: weaving the tapestry of comorbidity. Ann Fam Med. 2006;4(2):101–3.PubMedCrossRef
211.
Beasley JW, Hankey TH, Erickson R, et al. How many problems do family physicians manage at each encounter? A WReN study. Ann Fam Med. 2004;2(5):405–10.PubMedCrossRef
212.
Flocke SA, Goodwin MA, Stange KC. The effect of a secondary patient on the family practice visit. J Fam Pract. 1998;46(5):429–34.PubMed
213.
Flocke SA, Frank SH, Wenger DA. Addressing multiple problems in the family medicine office visit. J Fam Pract. 2001;50(3):211–6.PubMed
214.
Howie JG, Heaney DJ, Maxwell M. Care of patients with selected health problems in fundholding practices in Scotland in 1990 and 1992: needs, process and outcome. Br J Gen Pract. 1995;45(392):121–6.PubMed
215.
Franks P, Clancy CM, Nutting PA. Gatekeeping revisited–protecting patients from overtreatment. N Engl J Med. 1992;327(6):424–9.PubMedCrossRef
216.
217.
Bright Futures Tools for Professionals. Cultural Competence Assessment—Primary Care.
218.
Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130(10):829–34.PubMed
219.
220.
Orzano AJ, Gregory PM, Nutting PA, Werner JJ, Flocke SA, Stange KC. Care of the secondary patient in family practice. A report from the Ambulatory Sentinel Practice Network. J Fam Pract. 2001;50(2):113–8.PubMed
221.
222.
Egnew TR. Suffering, meaning, and healing: challenges of contemporary medicine. Ann Fam Med. 2009;7(2):170–5.PubMedCrossRef
223.
Scott JG, Cohen D, DiCicco-Bloom B, Miller WL, Stange KC, Crabtree BF. Understanding healing relationships in primary care. Ann Fam Med. 2008;6(4):315–22.PubMedCrossRef
224.
Hsu C, Phillips WR, Sherman KJ, Hawkes R, Cherkin DC. Healing in primary care: a vision shared by patients, physicians, nurses, and clinical staff. Ann Fam Med. 2008;6(4):307–14.PubMedCrossRef
225.
Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ. 2003;327(7425):1219–21.PubMedCrossRef
226.
Saultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004;2(5):445–51.PubMedCrossRef
227.
Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med. 2005;3(2):159–66.PubMedCrossRef
228.
Mainous AG 3rd, Goodwin MA, Stange KC. Patient-physician shared experiences and value patients place on continuity of care. Ann Fam Med. 2004;2(5):452–4.PubMedCrossRef
229.
Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC. Continuity of primary care: to whom does it matter and when? Ann Fam Med. 2003;1(3):149–55.PubMedCrossRef
230.
Epstein RM, Fiscella K, Lesser C, Stange KC. Defining and Achieving Patient-Centered Care: The Role of Clinicians, Patients and Healthcare Systems. Health Aff (Millwood). 2009;(in press).
231.
Scott T, Mannion R, Davies H, Marshall M. The quantitative measurement of organizational culture in health care: a review of the available instruments. Health Serv Res. 2003;38(3):923–45.PubMedCrossRef
232.
Rivo ML, Saultz JW, Wartman SA, DeWitt TG. Defining the generalist physician's training. Jama. 1994;271(19):1499–504.PubMedCrossRef
233.
Haight RO, Marsland DW, Mitchell GS Jr. Clinical and educational implications of a longitudinal audit for asthma. J Fam Pract. 1976;3(5):481–5.PubMed
234.
Marsland DW, Wood M, Mayo F. Content of family practice. Part I. Rank order of diagnoses by frequency. Part II. Diagnoses by disease category and age/sex distribution. J Fam Pract. 1976;3(1):37–68.PubMed
235.
Marsland DW, Wood M, Mayo F. A data bank for patient care, curriculum, and research in family practice: 526, 196 patient problems. J Fam Pract. 1976;3(1):25–8.PubMed
236.
Stange KC, Zyzanski SJ, Jaén CR, et al. Illuminating the 'black box'. A description of 4454 patient visits to 138 family physicians. J Fam Pract. 1998;46(5):377–89.PubMed
237.
DesRoches CM, Campbell EG, Rao SR, et al. Electronic health records in ambulatory care--a national survey of physicians. N Engl J Med. 2008;359(1):50–60.PubMedCrossRef
238.
McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.PubMedCrossRef
239.
Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human. Building a safer health system. Washington: National Academy Press; 2000.
240.
Fortin M, Dionne J, Pinho G, Gignac J, Almirall J, Lapointe L. Randomized controlled trials: do they have external validity for patients with multiple comorbidities? Ann Fam Med. 2006;4(2):104–8.PubMedCrossRef
241.
Callahan EJ, Jaén CR, Crabtree BF, Zyzanski SJ, Goodwin MA, Stange KC. The impact of recent emotional distress and diagnosis of depression or anxiety on the physician-patient encounter in family practice. J Fam Pract. 1998;46(5):410–8.PubMed
242.
Medalie JH, Zyzanski SJ, Langa D, Stange KC. The family in family practice: is it a reality? J Fam Pract. 1998;46(5):390–6.PubMed
243.
Mold JW, Blake GH, Becker LA. Goal-oriented medical care. Fam Med. 1991;23(1):46–51.PubMed
244.
Seifert MH. Patient advisory council cuts malpractice costs. Patient Educ Newsl. 1984;7(5):1–2.PubMed
245.
Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K. On the front lines of care: primary care doctors' office systems, experiences, and views in seven countries. Health Aff (Millwood). 2006;25(6):w555–71.CrossRef
246.
Scheffler R, Bodenheimer T, Lombardo P, et al. The future of primary care--the community responds. N Engl J Med. 2008;359(25):2636–9.PubMedCrossRef
247.
Lee TH, Bodenheimer T, Goroll AH, Starfield B, Treadway K. Perspective roundtable: redesigning primary care. N Engl J Med. 2008;359(20):e24.PubMedCrossRef
248.
249.
Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv. 2007;37(1):111–26.PubMedCrossRef
250.
Geyman J. The corporate transformation of health care: can the public interest still be served? New York: Springer Publishing Company; 2004.
251.
Geyman JP. Health care in America: can our ailing system be healed? Boston: Butterworth-Heinemann; 2002.
252.
Bobrow RS. The unintended consequences of measuring quality on the quality of medical care. N Engl J Med. 2000;342(7):519. author reply 520.PubMedCrossRef
253.
Acheson LS, Stange KC, Zyzanski S. Clinical genetics issues encountered by family physicians. Genet Med. 2005;7(7):501–8.PubMedCrossRef
254.
O'Neill SM, Rubinstein WS, Wang C, et al. Familial risk for common diseases in primary care: the Family Healthware Impact Trial. Am J Prev Med. 2009;36(6):506–14.PubMedCrossRef
255.
Rhyne R, Bogue R, Kukulka G, Fulmer H, eds. Community-oriented primary care: health care for the 21st century. Washington: American Public Health Association; 1998.
256.
Stange KC, Gjeltema K, Woolf SH. One minute for prevention: the power of leveraging to fulfill the promise of health behavior counseling. Am J Prev Med. 2002;22(4):320–3.PubMedCrossRef
257.
Stange KC, Woolf SH. Policy options to enable high-value preventive care: an analysis commissioned by the partnership for prevention. Washington: Partnership for Prevention; 2008.
258.
Woolf SH, Stange KC. A sense of priorities for the health care commons. Am J Prev Med. 2006;31(1):99–102.PubMedCrossRef
259.
Etz RS, Cohen DJ, Woolf SH, et al. Bridging primary care practices and communities to promote healthy behaviors. Am J Prev Med. 2008;35:S390–7.PubMedCrossRef
260.
Green LW, Cifuentes M, Glasgow RE, Stange KC. Redesigning primary care practice to incorporate health behavior change: prescription for health round 2 results. Am J Prev Med. 2008;35:S347–9.PubMedCrossRef
261.
Nutting P. Community-oriented primary care: From principle to practice. Washington, DC: U.S. Government Printing Office; 1987. DHHS Publication No. HRS-A-PE 86-1 (Now available from the University of New Mexico Press)
262.
Task Force on Community Preventive Services. The Community Guide: What Works to Promote Health: Community Guide Branch National Center for Health Marketing (NCHM) Centers for Disease Control and Prevention 2009.
263.
Willis J. Friends in low places. Abingdon, Oxon: Radcliffe Medical Press; 2001.
264.
Sox HC. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–6.
265.
Willis J. The paradox of progress. Abingdon, Oxon: Radcliff Medical Press, Ltd; 2002.
266.
Doran T, Fullwood C, Gravelle H, et al. Pay-for-performance programs in family practices in the United Kingdom. N Engl J Med. 2006;355(4):375–84.PubMedCrossRef
267.
Grant S, Huby G, Watkins F, et al. The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study. Sociol Health Illn. 2009;31(2):229–45.PubMedCrossRef
268.
Robinson JC, Casalino LP, Gillies RR, Rittenhouse DR, Shortell SS, Fernandes-Taylor S. Financial incentives, quality improvement programs, and the adoption of clinical information technology. Med Care. 2009;47(4):411–7.PubMedCrossRef
269.
Geyman J. Shredding the social contract: the privatization of medicare. Monroe: Common Courage Press; 2006.
270.
Geyman J. The corrosion of medicine: can the profession reclaim its moral legacy? Monroe: Common Courage Press; 2008.
271.
Brody H. Hooked: ethics, the medical profession, and the pharmaceutical industry. Lanham: Rowman & Littlefield Publishers, Inc.; 2007.
272.
Metadata
Title
Defining and Measuring the Patient-Centered Medical Home
Authors
Kurt C. Stange, MD, PhD
Paul A. Nutting, MD, MSPH
William L. Miller, MD, MA
Carlos R. Jaén, MD, PhD
Benjamin F. Crabtree, PhD
Susan A. Flocke, PhD
James M. Gill, MD, MPH
Publication date
01-06-2010
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 6/2010
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-010-1291-3

Other articles of this Issue 6/2010

Journal of General Internal Medicine 6/2010 Go to the issue

Healing Arts

A Conductor Confronts Cacophony

Clinical Review

Good Neighbors: How Will the Patient-Centered Medical Home Relate to the Rest of the Health-Care Delivery System?

Review

US Approaches to Physician Payment: The Deconstruction of Primary Care

Letter to the Editor

Family Caregivers, Patients and Physicians: Ethical Guidance to Optimize Relationships

Original Article

Perspectives of Non-Hispanic Black and Latino Patients in Boston’s Urban Community Health Centers on their Experiences with Diabetes and Hypertension

Original Article

Obesity Diagnosis and Care Practices in the Veterans Health Administration

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits