to offer new services or deliver care in a new manner (e.g., preventive home visits and use of interdisciplinary teams).

It should be noted that CMS is implementing a new Medical Home demonstration program in 2008 that is similar in many ways to the advanced medical home concept. According to the statutory language, physicians will be required to (1) provide ongoing support, oversight, and guidance to implement an integrated, coherent, cross-discipline plan for ongoing medical care, which will be developed in partnership with the patient and all other physicians, medical personnel, and agencies (e.g., home health agencies) providing care to the patient; (2) use evidence-based medicine and clinical decision support tools to guide decision making; (3) use health information technology (e.g., remote monitoring and patient registries) to monitor and track the health status of patients and to provide them with enhanced and convenient access to services; and (4) encourage patients to engage in the management of their own health through education and support systems (CMS, 2008b). Participating physicians will be reimbursed under the traditional Medicare Physician Fee Schedule but will also be eligible for a care-management fee for each participating beneficiary under their care and a bonus based on the achievement of savings and quality goals (ACP, 2006). However, while the concept of an advanced medical home was intended to be applicable to all individuals, the demonstration project will be limited to those with multiple chronic illnesses.


Identifying successful models of care is just the first challenge in improving the delivery of services to older adults. Successful models need to be replicated and incorporated widely into practice in order to reach a large patient population, and, in general, the adoption of best practices has occurred very slowly in the health care sector as well as other industries (Berwick, 2003). Indeed, evidence shows that innovations that have been demonstrated to improve the quality of patient care can take more than 17 years to become common practice (Balas and Boren, 2000). Little is known about the best way to promote the exchange of information concerning how to improve the quality of care (IOM, 2006a). Rogers’ diffusion of innovations theory defined five categories related to the adopters of new practices:

  • Innovators, who embrace new ideas

  • Early adopters, who are the opinion leaders of a community

  • Early majority, who are convinced by the early adopters to adopt the innovation

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