Orchestrating large organizational change in primary care: The Veterans' Health Administration experience implementing a patient-centered medical home

摘要

The Veterans Health Administration (VHA) has been on an evolving journey to achieve a system-wide approach to care that enables the patient-centered medical home to serve as the focal point of a medical neighborhood, closely integrating primary care, mental health, specialty care, and inpatient care, and spanning the continuum of care from health to palliative care. The journey began in the closing years of the 20th century with a forward thinking paradigm that perceived health care from the context of one large integrated system based upon team-based care with the foundation centered within a well-constructed primary care team. Over the past decade, VHA has accelerated its progression from a hospital-based system to one that has primary care as its foundation.