Article Figures & Data
Tables
- Table 1
Quantitative PCMH Evaluation Measures: Practice, Clinician, and Staff Survey Instruments
Measurement Tool Domains Source, Version, Purpose, Availability Baseline Practice Survey45 Demographics and practice information Original NDP questionnaire (96 items). Adapted questionnaire by BPCTI (27 items). Provides information for NCQA and meaningful use. No cost
Supplemental Appendix 1, http://www.annfammed.org/content/13/2/168/suppl/DC1PCMH Implementation Survey45,46 Change capacity: teamwork, work environment, culture, trust, communication Modified by BPCTI from 2 longer NDP scales: NDP Practice Adaptive Reserve (23 items), Modified Scale = 23 items (reflection item deleted and confidence item added), and Practice Environmental Checklist (123 items). Combined modified scale = 32 items. No cost
Supplemental Appendix 2, http://www.annfammed.org/content/13/2/168/suppl/DC1Practice Demographic Questionnaire for clinicians Demographics of individual practice clinicians BPCTI (9 items). For physicians, NPs, and PAs. No cost
Supplemental Appendix 3, http://www.annfammed.org/content/13/2/168/suppl/DC1Practice Demographic Questionnaire for staff Demographics of individual practice staff BPCTI (5 items). For nurses, medical assistants, receptionists, and other staff. No cost
Supplemental Appendix 4, http://www.annfammed.org/content/13/2/168/suppl/DC1The Clinician Activation Measure assessment (CS-PAM) Clinician support for and beliefs about patient activation and patient self-management Validated tool from Insignia Health (13 items). Requires purchase of a license
http://www.insigniahealth.com/solutions/clinician-activation-measureMaslach Burnout Inventory47 Measure of burnout: emotional exhaustion, depersonalization, personal accomplishment MBI-HSS (22 items). For clinicians and staff. Available in 25 languages, free with purchase of license for English version. Website disclaimer gives no warranty for translation quality
http://www.mindgarden.com/products/mbi.htm-
BPCTI = Brown Primary Care Transformation Initiative; MBI = Maslach Burnout Inventory; MBI-HSS = MBI-Human Services Survey; NCQA = National Center for Quality Assurance; NDP = National Demonstration Project; NP = nurse practitioner; PA = physician assistant; PCMH = patient-centered medical home.
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Measurement Tool Domains Source, Version, Purpose, Availability Patient Activation Measure (PAM) Patient activation regarding patients’ knowledge, skills, and confidence for self-management Validated tool from Insignia Health (13 items) to inform patient activation efforts English and Spanish. Requires purchase of a license
http://www.insigniahealth.com/solutions/patient-activation-measureHRSA Patient Satisfaction Survey Adult experiences of care at the practice HRSA (32 items). English and Spanish. No cost. HRSA version 12/25/2012
Supplemental Appendix 5, http://www.annfammed.org/content/13/2/168/suppl/DC1Interpersonal Process of Care Survey: Short Form (IPC-18) Communication, patient-centered decision making, and interpersonal style University of California, San Francisco Department of Medicine, Center for Aging in Diverse Communities (18-item short form). For patients from diverse racial/ethnic groups to describe disparities in interpersonal care, predict patient outcomes, and examine outcomes disparity reduction efforts. English and Spanish. No cost
http://dgim.ucsf.edu/cadc/mm/ipcare.html-
HRSA = Health Resources and Services Administration; PCMH = patient-centered medical home.
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Measurement Tool Domains Source, Version, Purpose, Availability Physician Practice Connections – Patient-Centered Medical Home (PPC-PCMH) 9 Standards: access and communication, patient tracking and registry functions, care management, self-management support, electronic prescribing, test tracking, referral tracking, performance reporting and improvement, advanced electronic communication NCQA revised standards for January 1, 2014. Most commonly used measure of PCMH accreditation
http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspxMeaningful Use 3 Core areas: data capture and sharing, advancing clinical processes, achieving improved patient outcomes Standards defined by the CMS Incentive Programs to regulate use of electronic health records. Eligible providers and hospitals earn incentive payments by meeting criteria
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.htmlMedical Home Implementation Quotient (MHIQ) 9 Modules: patient-centered medical home, practice management, health information technology, quality and safety, practice-based team care, care coordination, practice-based services, access to care and information, care management TransforMED. Self-assessment tool to help a practice learn more about the medical home model and gauge status within the medical home continuum
http://www.transformed.com/mhiq/welcome.cfmPatient-Centered Medical Home Assessment (PCMH-A) 8 Change concept areas: engaged leadership, quality improvement strategy, empanelment, continuous team-based healing relationships, organized, evidence-based care, patient-centered interactions, enhanced access, care coordination MacColl Center for Healthcare Innovation. Helps practices gauge progress implementing PCMH change concepts. Tested by 65 sites participating in the Safety Net Medical Home Initiative
http://bsmod.dom.wustl.edu/documents/PCMH-A_SNMHI_080410.pdf-
CMS = Centers for Medicare & Medicaid Services; NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home.
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Hospital admissions per 1,000 members Ambulatory care–sensitive conditions admissions per 1,000 members Emergency department visits per 1,000 members Avoidable emergency visits (ambulatory care–sensitive admissions per 1,000 members) Hospital readmissions within 30 days Adult measurement category examples Comprehensive diabetes care Tobacco use assessment and counseling Hypertension control Breast cancer screening Cervical cancer screening Colorectal cancer screening Depression screening and treatment Weight, BMI screening Asthma treatment Cholesterol management Pediatric measurement category examples Well-child checks Immunizations Developmental screening BMI measurement and classification Patients with persistent asthma on controller medication Screening for chlamydia in sexually active adolescent girls Oral health risk assessment Hearing and vision checks Lead screening -
BMI = body mass index.
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Method Domains Source, Version, Purpose, Availability Direct observation within the practice environment (example: medical practice waiting room observation guide) Examples: use of space, people flow, and interpersonal interactions in waiting rooms, nurses’ stations and other back areas; décor and tone of each area; communication among clinicians, staff, and patients BPCTI. Participant observation sessions conducted throughout the practice at varying times and days of the week Flexibly structured field note template
Supplemental Appendix 6, http://www.annfammed.org/content/13/2/168/suppl/DC1Pathway observations with staff Staff experience of work. Observe work tasks and workflow for specific staff person and during interactions with coworkers: type of tasks, redundancy, efficiency, demeanor, behaviors, interactions BPCTI. Observation template guide
Supplemental Appendix 7, http://www.annfammed.org/content/13/2/168/suppl/DC1Pathway observations with adult and pediatric patients Patient (or parent or guardian) experience of visit. Observe workflow, patient data collection, confidentiality procedures, observation of clinician and staff communication with patient, parent, or guardian, time duration for visit segments BPCTI. Observation template guide. Researcher takes notes while accompanying patients from check-in through checkout. Informal interviewing during wait times
Supplemental Appendix 8, http://www.annfammed.org/content/13/2/168/suppl/DC1-
BPCTI = Brown Primary Care Transformation Initiative; PCMH = patient-centered medical home.
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Method Domains Source, Version, Purpose, Availability Used with clinicians and staff Individual baseline interviews with clinicians and staff Role description, perspective of and experience working in practice, teamwork, conflict resolution, change processes, goals for change BPCTI (20 core open-ended questions). In-person or telephone interview conducted with physicians, NPs, PAs, nurses, medical assistants, receptionists, and other staff.
Supplemental Appendix 9, http://www.annfammed.org/content/13/2/168/suppl/DC1Follow-up interviews with clinicians, PCMH practice champions, and staff Perceptions of transformation progress, vision of practice as a PCMH, roles in transformation efforts, communication, patient engagement, changes in interpersonal interactions BPCTI (19 core open-ended questions). In-person or telephone interview conducted with physicians, NPs and PAs, nurses, medical assistants, receptionists, and other staff.
Supplemental Appendix 10, http://www.annfammed.org/content/13/2/168/suppl/DC1Used with patients Individual adult patient interviews Patient’s experience and opinions about the practice, cognizance of practice transformation, understanding of PCMH BPCTI (12 core open-ended questions). In-person interview conducted with patients aged >18 y.
Supplemental Appendix 11, http://www.annfammed.org/content/13/2/168/suppl/DC1Individual or pair: parent or guardian and pediatric patient interviews Parent and child’s experience and opinions about the practice, cognizance of practice transformation, understanding of PCMH BPCTI (14 core open-ended questions). In-person interview conducted with parent or guardian alone, parent-child pair if child is capable of participating, or child alone if child is capable of speaking completely for him/herself.
Supplemental Appendix 12, http://www.annfammed.org/content/13/2/168/suppl/DC1-
BPCTI = Brown Primary Care Transformation Initiative; NP = nurse practitioner; PA = physician assistant; PCMH = patient-centered medical home.
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Method Domains Source, Version, Purpose, Availability Written reflections and progress notes Facilitation staff document the changing contextual circumstances in the practices, in the broader environment, and in their own facilitation roles BPCTI (5 trigger questions). Facilitation staff keep an ongoing typed log of reflections
Supplemental Appendix 13, http://www.annfammed.org/content/13/2/168/suppl/DC1Focus groups Moderated group discussions about enabling factors and barriers to achieving evaluation or facilitation goals, how staff roles and relationships with practices evolved and the impact of this evolution, and notions about how and why the practices are or are not transforming in specific domains BPCTI (4 core questions about evaluation data collection; 22 core questions about transformation facilitation)
Supplemental Appendix 14, http://www.annfammed.org/content/13/2/168/suppl/DC1-
BPCTI = Brown Primary Care Transformation Initiative; PCMH = patient-centered medical home.
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Additional Files
Supplemental Appendixes 1-14
PDF files. Last file listed is all 14 appendixes in a single PDF file.
Files in this Data Supplement:
- Supplemental data: Appendix 1 - PDF file
- Supplemental data: Appendix 10 - PDF file
- Supplemental data: Appendix 11 - PDF file
- Supplemental data: Appendix 12 - PDF file
- Supplemental data: Appendix 13 - PDF file
- Supplemental data: Appendix 14 - PDF file
- Supplemental data: Appendixes 1-14 - PDF file
- Supplemental data: Appendix 2 - PDF file
- Supplemental data: Appendix 3 - PDF file
- Supplemental data: Appendix 4 - PDF file
- Supplemental data: Appendix 5 - PDF file
- Supplemental data: Appendix 6 - PDF file
- Supplemental data: Appendix 7 - PDF file
- Supplemental data: Appendix 8 - PDF file
- Supplemental data: Appendix 9 - PDF file
The Article in Brief
Recommendations for a Mixed Methods Approach to Evaluating the Patient-Centered Medical Home
Roberta E. Goldman , and colleagues
Background The Patient-Centered Medical Home (PCMH) is intended to transform primary care practices by combining the best primary care attributes with new ways of structuring and coordinating care, engaging patients, improving health outcomes, providing a better patient experience, improving efficiency and use of health information technology, and reducing costs. This study develops a methodology for identifying how and why transformation occurs in primary care practices.
What This Study Found PCMH evaluation must be comprehensive enough to assess and explain the context of transformation in different primary care practices and the experiences of diverse stakeholders. The methods and measures proposed in this study are intended to be used together and include survey instruments, PCMH meta-measures, patient outcomes, quality measures, qualitative interviews, participant observation, and process evaluation.
Implications
- This approach, the authors conclude, 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. These insights, in turn, can inform recommendations for practice facilitation that can most effectively achieve the goals of the PCMH model.