title: Development and Validation of the Modified Patient-Centered Medical Home Assessment for the Comprehensive Primary Care Initiative.
abstract: To describe the modified Patient-Centered Medical Home Assessment (M-PCMH-A) survey module developed to track primary care practices' care delivery approaches over time, assess whether its underlying factor structure is reliable, and produce factor scores that provide a more reliable summary measure of the practice's care delivery than would a simple average of question responses.
  
  
  
  Survey data collected from diverse practices participating in the Comprehensive Primary Care (CPC) initiative in 2012 (n = 497) and 2014 (n = 493) and matched comparison practices in 2014 (n = 423).
  
  
  
  Confirmatory factor analysis.
  
  
  
  Thirty-eight questions organized in six domains: Access and Continuity of Care, Planned Care for Chronic Conditions and Preventive Care, Risk-Stratified Care Management, Patient and Caregiver Engagement, Coordination of Care across the Medical Neighborhood, and Continuous Data-Driven Improvement.
  
  
  
  Confirmatory factor analysis suggested using seven factors (splitting one domain into two), reassigning two questions to different domain factors, and removing one question, resulting in high reliability, construct validity, and stability in all but one factor. The seven factors together formed a single higher-order factor summary measure. Factor scores guard against potential biases from equal weighting.
  
  
  
  The M-PCMH-A can validly and reliably track primary care delivery across practices and over time using factors representing seven key components of care as well as an overall score. Researchers should calculate factor loadings for their specific data if possible, but average scores may be suitable if they cannot use factor analysis due to resource or sample constraints.
authors.affiliation: Mathematica Policy Research, Princeton, NJ.
authors.forename: Dmitriy
authors.identifier: 0000-0002-9610-8424
authors.initials: D
authors.lastname: Poznyak
authors.affiliation: Mathematica Policy Research, Princeton, NJ.
authors.forename: Deborah N
authors.initials: DN
authors.lastname: Peikes
authors.affiliation: Mathematica Policy Research, Washington, DC.
authors.forename: Breanna A
authors.initials: BA
authors.lastname: Wakar
authors.affiliation: Mathematica Policy Research, Princeton, NJ.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Brown
authors.affiliation: Trillium Health Partners and Institute for Health Policy, Management and Evaluation, University of Toronto, Mississauga, ON, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control / Q000628:therapy; D003266:Continuity of Patient Care / Q000458:organization & administration; D005163:Factor Analysis, Statistical; D019538:Health Care Surveys / Q000379:methods* / Q000592:standards; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D010358:Patient Participation / Q000379:methods; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D011314:Preventive Health Services / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011594:Psychometrics; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*; D015203:Reproducibility of Results
keywords: Psychometrics; quality improvement/report cards; quality of care/patient safety; survey research and questionnaire design