Development and Validation of the Modified Patient-Centered Medical Home Assessment for the Comprehensive Primary...

Area of Science:

• Primary care research
• Health services research
• Survey methodology

Background:

• The Patient-Centered Medical Home (PCMH) model aims to improve primary care delivery.
• Tracking changes in PCMH practice over time requires reliable assessment tools.
• Existing measures may not fully capture the multifaceted nature of PCMH care delivery.

Purpose of the Study:

• To describe the development of the modified Patient-Centered Medical Home Assessment (M-PCMH-A) survey module.
• To assess the reliability and factor structure of the M-PCMH-A.
• To generate factor scores for a more reliable measure of practice care delivery.

Main Methods:

• Confirmatory factor analysis was used to evaluate the M-PCMH-A's structure.
• Data were collected from primary care practices participating in the Comprehensive Primary Care (CPC) initiative.
• Survey data were collected in 2012 and 2014 from participating and comparison practices.

Main Results:

• Confirmatory factor analysis supported a seven-factor structure, with modifications to question assignments and one question removal.
• The M-PCMH-A demonstrated high reliability, construct validity, and stability across most factors.
• Seven factors formed a higher-order factor, providing a reliable summary measure of care delivery, guarding against weighting biases.

Conclusions:

• The M-PCMH-A is a valid and reliable tool for tracking primary care delivery longitudinally.
• The seven-factor structure and overall score provide robust measures of practice transformation.
• Researchers can use factor scores for precise measurement or average scores if factor analysis is not feasible.