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It's hard to hit a moving target.

Fam Pract Manag. 2009;16(4):5

One challenge faced by proponents of the patient-centered medical home (PCMH) is that the name is not very descriptive – or perhaps it's that the concept is hard to describe.

TransforMED, the AAFP subsidiary in the business of transforming primary care practices, offers a diagram it calls the TransforMED Patient-Centered Model (see it at It shows a somewhat daunting array of eight text “bubbles” surrounding a central core, with a total of 63 bullet points identifying features of the transformed practice.

The AAFP has recently rolled out a much simpler diagram – a “house” made up of five blocks and a roof. Each block carries one label: Practice Organization, Quality Measures, etc. You'll find the house diagram in the new PCMH section of the AAFP web site, at

How can one concept be depicted so differently? Partly it's just the way the details are presented. If you click on the blocks in the house diagram on the AAFP site or download the “PCMH Checklist” that's available there, you'll find that the house model contains plenty of bullet points as well. Still, with the house image, the Academy has chosen to depict the PCMH as simple and homey, so to speak, while TransforMED has chosen to emphasize the patient and the complexity of the model. Presumably it's a matter of what each organization wants to convey about the PCMH.

But part of the difference probably comes from the fact that the PCMH is a moving target. The TransforMED model was developed before the National Committee for Quality Assurance attempted to define PCMH standards ( and even before the AAFP and other primary care specialty societies developed “Joint Principles of the Patient-Centered Medical Home” ( Although the TransforMED model has evolved, it shows its origins. By contrast, the new AAFP model was developed with full awareness of these definitions.

The evolution of the PCMH isn't over yet, either. The more central the concept becomes to the current health care reform debate, the more energy stakeholders will devote to redefining it. One well-respected voice in the developing argument is that of Barbara Starfield, MD, MPH (see page 6).

By next year at the latest, the PCMH, and our representations of it, will very likely be remodeled. I wonder what the new floor plan will be?

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