• Type of Practice: Non-profit organization
• Location: Boston, Massachusetts
• Population Served: Approximately 239,000 children were served through the Massachusetts CHIPRA medical home learning collaborative through 13 participating pediatric practices.
  

• Recruit pediatric practices to participate in a statewide quality improvement project.
• Identify internal Practice Transformation Facilitators (PTFs) that will function as change agents for medical home transformation within each practice. Characteristics and advantages of PTFs include the following:
• Co-located and employed by the clinic.
• Understand the clinic's culture and contextual factors.
• Understand the local community.
• Use data to understand whether changes resulted in improvement.
• Use a disciplined approach to making changes including the Model for Improvement and Plan-Do-Study-Act cycles.

• Provide training and support to PTFs using a quality improvement curriculum.
• Utilize trainings to facilitate collaborative learning, brainstorming, and strategies to address challenges. Additional training for PTFs includes the following:
• Monthly conference calls with all PTFs.
• Quarterly PTF in-person trainings.
• In-person trainings during learning sessions, facilitated by project staff and quality improvement advisor.
  
• Partner with local organizations including the following:
• Children's Hospitals
• Universities
• Health Care Plans
• Non-profit Organization
• Develop a detailed evaluation methodology at the start of the project.
• Use validated tools to measure medical home such as the Medical Home Index.

• Challenges encountered throughout this project included the following:
• Resistance to change in practice culture
• Limited resources for medical home transformation within a particular practice
• Achieving buy-in from practice staff
• To overcome these challenges, Practice Transformation Facilitators (PTFs) engaged in collaborative learning and problem solving through monthly calls and quarterly in-person meetings.
  

• For more information, contact Emma Smizik, MPH, Senior Project Manager at the National Institute for Children's Health Quality at esmizik@nichq.org.
• Visit the CHIPRA Massachusetts Medical Home Initiative Web site to view the following:
• Care Plan Templates
• Family Engagement Guide
• Care Coordination Paper
• Care Team Role Builder
• Creating a Patient and Family Advisory Council:  A Toolkit for Pediatric Practices
• Medical Home Transformation Crosswalk