Ensuring that all Americans have a medical home is a first step toward creating a patient-centered health system, say Davis and colleagues. They argue that a package of patient-centered services—such as e-mail visits, automated patient reminders, access to electronic medical records, and same-day appointments or walk-in hours—could be supported through a fixed monthly fee. In addition, pay-for-performance contracts similar to those employed in the United Kingdom could encourage primary care practices to measure and improve the quality of care they deliver. Demonstration projects could test the viability of such models, helping to develop a "business case" for providing patient-centered care.

Fund-supported efforts are seeking to answer the challenge put forth in "A 2020 Vision." The National Committee for Quality Assurance (NCQA), for example, has been developing and testing a comprehensive set of measures to see how well patient-centered care has taken hold in physician practices. Of the patient survey instruments currently in use, most examine individual providers' performance, but quality improvement experts emphasize the importance of practice structure and environment in the quality of care patients receive. The NCQA measurement set expands and complements patient survey measures to assess a physician practice's systems, taking into account, for example, patients' access to medical records, their involvement in quality improvement activities, and systems to coordinate care between providers.

So far, NCQA has incorporated 18 of these patient-centered care measures in the standards for its Physician Practice Connections program, which recognizes practices that use information systems to improve patient care. The program is part of Bridges to Excellence, a physician pay-for-performance program sponsored by several large corporations.

A project led by Dana Safran, Sc.D., of Tufts-New England Medical Center is examining the strength of the relationship between patient experience and clinical quality and outcomes at the individual physician and practice levels. The results from this work will provide much-needed information to motivate greater investment in and commitment to patient-centered care. In particular, it should encourage practices to routinely solicit feedback from patients about their health care experiences.