title: Evaluation of patient centered medical home practice transformation initiatives.
abstract: BACKGROUND
  The patient-centered medical home (PCMH) has become a widely cited solution to the deficiencies in primary care delivery in the United States. To achieve the magnitude of change being called for in primary care, quality improvement interventions must focus on whole-system redesign, and not just isolated parts of medical practices.
  
  
  METHODS
  Investigators participating in 9 different evaluations of Patient Centered Medical Home implementation shared experiences, methodological strategies, and evaluation challenges for evaluating primary care practice redesign.
  
  
  RESULTS
  A year-long iterative process of sharing and reflecting on experiences produced consensus on 7 recommendations for future PCMH evaluations: (1) look critically at models being implemented and identify aspects requiring modification; (2) include embedded qualitative and quantitative data collection to detail the implementation process; (3) capture details concerning how different PCMH components interact with one another over time; (4) understand and describe how and why physician and staff roles do, or do not evolve; (5) identify the effectiveness of individual PCMH components and how they are used; (6) capture how primary care practices interface with other entities such as specialists, hospitals, and referral services; and (7) measure resources required for initiating and sustaining innovations.
  
  
  CONCLUSIONS
  Broad-based longitudinal, mixed-methods designs that provide for shared learning among practice participants, program implementers, and evaluators are necessary to evaluate the novelty and promise of the PCMH model. All PCMH evaluations should as comprehensive as possible, and at a minimum should include a combination of brief observations and targeted qualitative interviews along with quantitative measures.
authors.affiliation: Department of Family Medicine, Robert Wood Johnson Medical School, Somerset, NJ 08873, USA. Crabtrbf@umdnj.edu
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Chase
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wise
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
authors.forename: Laura A
authors.initials: LA
authors.lastname: Schmidt
authors.forename: Jeanette R
authors.initials: JR
authors.lastname: Goyzueta
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Malouin
authors.forename: Susan M C
authors.initials: SM
authors.lastname: Payne
authors.forename: Michael T
authors.initials: MT
authors.lastname: Quinn
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
authors.forename: William L
authors.initials: WL
authors.lastname: Miller
authors.forename: Carlos Roberto
authors.initials: CR
authors.lastname: Jaén
mesh_terms: D003299:Cooperative Behavior; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D007373:Interinstitutional Relations; D008137:Longitudinal Studies; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D024382:Professional Role; D011787:Quality of Health Care / Q000458:organization & administration*; D012107:Research Design; D018511:Systems Integration