title: Recommendations for a mixed methods approach to evaluating the patient-centered medical home.
abstract: OBJECTIVE
  There is a strong push in the United States to evaluate whether the patient-centered medical home (PCMH) model produces desired results. The explanatory and contextually based questions of how and why PCMH succeeds in different practice settings are often neglected. We report the development of a comprehensive, mixed qualitative-quantitative evaluation set for researchers, policy makers, and clinician groups.
  
  
  METHODS
  To develop an evaluation set, the Brown Primary Care Transformation Initiative convened a multidisciplinary group of PCMH experts, reviewed the PCMH literature and evaluation strategies, developed key domains for evaluation, and selected or created methods and measures for inclusion.
  
  
  RESULTS
  The measures and methods in the evaluation set (survey instruments, PCMH meta-measures, patient outcomes, quality measures, qualitative interviews, participant observation, and process evaluation) are meant to be used together. PCMH evaluation must be sufficiently comprehensive to assess and explain both the context of transformation in different primary care practices and the experiences of diverse stakeholders. In addition to commonly assessed patient outcomes, quality, and cost, it is critical to include PCMH components integral to practice culture transformation: patient and family centeredness, authentic patient activation, mutual trust among practice employees and patients, and transparency, joy, and collaboration in delivering and receiving care in a changing environment.
  
  
  CONCLUSIONS
  This evaluation set offers a comprehensive methodology to enable understanding of how PCMH transformation occurs in different practice settings. This approach can foster insights about how transformation affects critical outcomes to achieve meaningful, patient-centered, high-quality, and cost-effective sustainable change among diverse primary care practices.
authors.affiliation: Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island Roberta_Goldman@brown.edu.
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Goldman
authors.affiliation: Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Parker
authors.affiliation: Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Joanna
authors.initials: J
authors.lastname: Brown
authors.affiliation: Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Judith
authors.initials: J
authors.lastname: Walker
authors.affiliation: Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.affiliation: Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Borkan
mesh_terms: D000288:Administrative Personnel; D003299:Cooperative Behavior; D017408:Guidelines as Topic; D006801:Humans; D018802:Patient-Centered Care / Q000592:standards*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care; D012107:Research Design; D014481:United States
keywords: context; evaluation; mixed methods; patient-centered medical home; practice transformation; qualitative methods; quantitative methods