1. Kangovi, Shreya MD, MS
  2. Kellom, Katherine
  3. Sha, Christopher MD
  4. Johnson, Sarah MD
  5. Chanton, Casey MSW
  6. Carter, Tamala CHW
  7. Long, Judith A. MD
  8. Grande, David MD, MPA


To explore perceptions of high-risk patients and their practice staff on the patient-centered medical home, we conducted a multisite qualitative study with chronically ill, low-income patients and their primary care practice staff (N = 51). There were 3 key findings. Both patients and staff described a trade-off: timely care from an unfamiliar provider versus delayed access to their personal physician. Staff were enthusiastic about enhancing access through strategies such as online communication, yet high-risk patients viewed these as access barriers. Practices lacked capacity to manage high-risk patients and therefore frequently referred them to the emergency room.