Improving Patient Care and Experiences in the Military Health System


The issues of limited access to care, patient dissatisfaction, and rising costs of healthcare, as well as improving the delivery and quality of care provided the MHS, called for the reformation of primary care and subsequent transition to Patient-Centered Medical Home (PCMH).

PCMH is a model of care delivery that supports all four goals for the Quadruple Aim for the Military Health System and upholds that healthcare provided in the primary care setting should be easily accessible to patients, comprehensive, patient-centered, and coordinated while provided by staff who are compassionate, culturally competent, working as a team to provide continuity to patients and families.

GSN FNP 4-Goal Patient Centered Medical Home Model- Access, Engagement, Inculcation, Patient Care


GSN FNP students completed a program evaluation of a military clinic’s transition to the Patient-Centered Medical Home model of care to determine how the current state aligned with the National Center for Quality Assurance PCMH 2011 Standard 1: Enhance Access and Continuity and Standard 3: Plan and Manage Care. Variances identified during the evaluation were used to create evidenced-based recommendations for improvement.

Variances, defined as non-adherence to NCQA criteria or failure to abide by the clinic’s own policy, were identified in 47% of the 58 Factors which were classified into four categories: Safety & Quality of Care, Access to Care, Patient Education, and PCMH Training.


Overall, the clinic was successful in its use of the electronic health record and laid the groundwork to improve access to care through electronic means. However, opportunities for improvement were also identified amongst the 58 individual Factors evaluated from the NCQA PCMH 2011 Standards 1 and 3.

Our students found that across all 4 categories, three common themes emerged: 1) poor communication, 2) inadequate training and reinforcement of PCMH concepts, and 3) insufficient use of emerging technologies from which evidence-based recommendations for improvement were made to the leadership.

The findings and evidenced-based recommendations were presented to local leadership and multiple national conferences. Local stakeholders were quick to address variances with process improvement and policy changes, and the work used to support Army-wide policy changes on PCMH training. This project provided an objective evaluation of PCMH implementation and served to invigorate the organizations’ desire to transform into a patient-centered culture and provided the impetus to change clinical practice.