Health Care Homes: development of a readiness assessment tool

In evaluation

31 August 2017

Funding Amount:




Melbourne Macedon Ranges Yarra Moonee Valley Darebin Maribyrnong Hobsons Bay Wyndham Brimbank Moorabool Melton Hume Merri-bek


On 31 March 2016, the Australian Government announced its plan to introduce stage one of a Health Care Home model to improve care for patients with chronic and complex conditions. This is based on the Patient-Centred Medical Home model that has been adopted in the USA. Under the Health Care Home model, eligible patients will voluntarily enrol with a participating medical practice known as their Health Care Home. This practice will provide a patient with a ‘home base’ for the ongoing coordination, management and support of their conditions.

This new Health Care Homes model will initially be tested in 10 geographical regions based on Primary Health Network boundaries. While North Western Melbourne PHN is not part of this initial demonstration, we are nevertheless deeply committed to supporting general practice to build its capacity to adopt this new model of care. As such, North Western Melbourne PHN is focusing its innovation portfolio on advancing the understanding of, and preparedness for, the Health Care Homes model in our region.

In partnership with the successful applicant, North Western Melbourne PHN will work to develop a tool to be used by general practices. This tool will be created following a literature review and targeted consultation on the DoH Health Care Home model as well as the broader Patient-Centred Medical Home model on which it is based. The tool will be used to self-assess the practice’s readiness to adopt a Health Care Homes model of service delivery. This project involves the creation of a self-assessment tool, but not the testing or implementation of the tool.

The tool will be designed so that practices can assess incremental progress toward full implementation of the Health Care Home model when they use it repeatedly. The data gained from this tool will be detailed enough to be used to stratify general practices within the region. The final format of the tool, paper or digital, should be determined by the consultant.


The following objectives are to be achieved by the project:

  • To examine the existing evidence base via literature review and obtain expert advice via targeted consultation to inform development of a general practice readiness assessment tool for Health Care Homes.
  • To produce a fit-for-purpose general practice readiness assessment tool with reference to the existing evidence base around appropriate tools, standards and critical success factors that have been shown to support a transition to a Health Care Home model, which could be a recommendation for an existing tool or an amalgamation of multiple existing tools.

Service involved