The main obstacle to improved performance, he says, is the apparent difficulty physicians have in redistributing workload in their practices. "They were socialized that the physician does everything, that they're the captain of their ship," Crabtree says.
"Medical school does that to them. But now there is the reluctance among some physicians to give up autonomy. They need to have a more distributed leadership style."
Care coordinators need to work with nurse practitioners, physicians, and others in the practice. And they need to have certain skill sets, formalized training programs for which do not yet exist.
"Most of the places that are really successful at this are training their own people, but that's not a very viable model for broad dissemination," Crabtree says.
Friedberg says that the researchers were "surprised" at the lackluster results from this three-year study because these practices that were patient-centered medical homes were large, and had been among the longest running PCMH model practices in the country.
In summary, Friedberg says that the study demonstrates loud and clear that doctors and policy makers "are still really new at this. It's not an area where we've had a lot of experience, and so we're definitely still in an experimental phase.
"We really won't know what works until we test it."