Expanding the primary care patient-centered medical home through new roles for registered nurses

New models of health care delivery such as the patient-centered medical home have emerged to address the Triple Aim of improving the health and the care of patients with the benefit of reducing the cost of quality primary care. The Donabedian approach of addressing structure and process to produce quality outcomes is used to introduce an innovative model of the patient-centered medical home that includes nurses as part of the interdisciplinary team of care providers. New nursing roles and processes are described that optimally utilize electronic health record technology to improve care coordination and care delivery. Economic outcomes have been realized in the form of incentives to a primary care practice and reimbursement for quality, cost-effective care. Recognition of outstanding quality care in this new model demonstrates how an effective care system is evolving to meet the changing health care needs of the population.