Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

Elena Bastida

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

William Darrow

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Patria Rojas

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Adriana Campa

Fourth Advisor's Committee Title

Committee Member


patient-centered medical home, chronic disease management, community health centers

Date of Defense



The Patient-Centered Medical Home (PCMH) model has attracted the attention of numerous health organizations in the United States for its potential to enhance quality of care and improve health outcomes among those living with chronic diseases. Community Health Centers (CHCs) funded by HRSA have been implementing this model for several years. Nevertheless, not all have achieved anticipated improvements. Several researchers have suggested that organizational factors may have a more determining role than the actual implementation of the PCMH model.

This qualitative case study explored organizational factors that distinguished or affected PCMH implementation at two CHCs with PCMH status recognized by HRSA as high-quality leaders. Three objectives were proposed: 1) compare and contrast organizational factors identified in the two CHCs; 2) describe how these CHCs implemented PCMH elements related to chronic disease management; and 3) propose an organizational framework to support PMCH implementation among CHCs. Three data collection procedures were employed: field observations, document review/analysis, and interviews.

Findings highlight the influence of organizational structure and organizational culture on PCMH implementation and chronic disease management initiatives. It also heightens the impact of multilevel efforts on the implementation of a complex organizational model like the PCMH. Other identified facilitators include the establishment of a “patient-centered” culture, active engagement of top-level leadership, and availability of full-functioning health care teams supporting care coordination and implementation of the model across the organization. Findings also highlighted structural factors affecting PCMH implementation such as changes from one PCMH-accrediting agency to another, which can destabilize PCMH implementation; the choice of an individual site instead of an organizational-level PCMH implementation, which can lead to lack of commitment among sites not recognized; and the high level of complexity of a multiple-site implementation.

This study is expected to contribute to the work of CHCs, an essential component of the US health system playing a key role in helping accomplish the nation’s health goals. Given their role in the fight against chronic diseases, public health practitioners should pay attention to how well these organizations are moving toward the accomplishment of their mission and examine factors that can improve their performance in this endeavor.





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