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Methods for evaluating practice change toward a patient-centered medical home
Carlos Roberto Jaén1, Benjamin F Crabtree, Raymond F Palmer
1Department 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
Annals of Family Medicine
|June 10, 2010
Summary
Evaluating the first national patient-centered medical home (PCMH) demonstration project required a mixed-methods approach. This study details the methods used to assess PCMH transformation, highlighting challenges and feasibility for future practice change evaluations.
Area of Science:
- Health Services Research
- Primary Care Transformation
- Implementation Science
Background:
- Patient-centered medical homes (PCMHs) represent a significant shift in primary care delivery.
- Understanding the complexities of practice transformation is crucial for successful implementation.
- The first national demonstration project aimed to evaluate PCMH implementation strategies.
Purpose of the Study:
- To describe the methods used to evaluate the national demonstration project of the PCMH concept.
- To emphasize quantitative measures and lessons learned for multimethod evaluation approaches.
- To understand the change process, multilevel outcomes, and context of PCMH transformation.
Main Methods:
- A group-randomized clinical trial design was employed for the National Demonstration Project (NDP).
- An independent evaluation team utilized integrated quantitative and qualitative methods.
- Data collection included medical record audits, patient and staff surveys, direct observation, and interviews.
Main Results:
- Real-time feedback from analyses aided facilitators.
- Medical record audits assessed process-of-care outcomes.
- Patient surveys captured patient-rated primary care attributes and outcomes.
- Ethnographic observations provided insights into practice development.
Conclusions:
- A multimethod approach, though challenging, is feasible and essential for evaluating practice development.
- Longitudinal follow-up of PCMH practices and patients is recommended.
- Lessons learned offer transferable insights for practice, policy, education, and research.
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