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Objective To describe the properties of the Patient-Centered Medical Home Assessment ( PCMH-A) as a tool to stimulate and monitor progress among primary care practices interested in transforming to patient-centered medical homes ( PCMHs). Study Setting Sixty-five safety net practices from five states participating in a national demonstration program for PCMH transformation. Study Design Longitudinal analyses of PCMH-A scores were performed. Scores were reviewed for agreement and sites were categorized over time into one of five categories by external facilitators. Comparisons to key activity completion rates and NCQA PCMH recognition status were completed. Data Collection/Extraction Methods Multidisciplinary teams at each practice completed the 33-item self-assessment tool every 6 months between March 2010 and September 2012. Principal Findings Mean overall PCMH-A scores increased (7.2, March 2010, to 9.1, September 2012; [ p < .01]). Increases were statistically significant for each of the change concepts ( p < .05). Facilitators agreed with scores 82% of the time. NCQA-recognized sites had higher PCMH-A scores than sites that were not yet recognized. Sites that completed more transformation activities and progressed over defined tiers reported higher PCMH-A scores. Scores improved most in areas where technical assistance was provided. Conclusions The PCMH-A was sensitive to change over time and provided an accurate reflection of practice transformation. [ABSTRACT FROM AUTHOR]