Methods for evaluating practice change toward a patient-centered medical home.
OBJECTIVE
Understanding the transformation of primary care practices to patient-centered medical homes (PCMHs) requires making sense of the change process, multilevel outcomes, and context. We describe the methods used to evaluate the country's first national demonstration project of the PCMH concept, with an emphasis on the quantitative measures and lessons for multimethod evaluation approaches.


METHODS
The National Demonstration Project (NDP) was a group-randomized clinical trial of facilitated and self-directed implementation strategies for the PCMH. An independent evaluation team developed an integrated package of quantitative and qualitative methods to evaluate the process and outcomes of the NDP for practices and patients. Data were collected by an ethnographic analyst and a research nurse who visited each practice, and from multiple data sources including a medical record audit, patient and staff surveys, direct observation, interviews, and text review. Analyses aimed to provide real-time feedback to the NDP implementation team and lessons that would be transferable to the larger practice, policy, education, and research communities.


RESULTS
Real-time analyses and feedback appeared to be helpful to the facilitators. Medical record audits provided data on process-of-care outcomes. Patient surveys contributed important information about patient-rated primary care attributes and patient-centered outcomes. Clinician and staff surveys provided important practice experience and organizational data. Ethnographic observations supplied insights about the process of practice development. Most practices were not able to provide detailed financial information.


CONCLUSIONS
A multimethod approach is challenging, but feasible and vital to understanding the process and outcome of a practice development process. Additional longitudinal follow-up of NDP practices and their patients is needed.
Jaén
Carlos Roberto
CR
Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. jaen@uthscsa.edu
Crabtree
Benjamin F
BF
Palmer
Raymond F
RF
Ferrer
Robert L
RL
Nutting
Paul A
PA
Miller
William L
WL
Stewart
Elizabeth E
EE
Wood
Robert
R
Davila
Marivel
M
Stange
Kurt C
KC
D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D005163:Factor Analysis, Statistical; D006302:Health Services Research / Q000191:economics / Q000379:methods; D006801:Humans; D017146:Models, Organizational; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000379:methods; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards* / Q000639:trends; D016730:Program Development / Q000191:economics / Q000379:methods; D011785:Quality Assurance, Health Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic