RT Journal Article
SR Electronic
T1 Methods for Evaluating Practice Change Toward a Patient-Centered Medical Home
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP S9
OP S20
DO 10.1370/afm.1108
VO 8
IS Suppl 1
A1 Carlos Roberto Jaén
A1 Benjamin F. Crabtree
A1 Raymond F. Palmer
A1 Robert L. Ferrer
A1 Paul A. Nutting
A1 William L. Miller
A1 Elizabeth E. Stewart
A1 Robert Wood
A1 Marivel Davila
A1 Kurt C. Stange
YR 2010
UL http://www.annfammed.org/content/8/Suppl_1/S9.abstract
AB PURPOSE Understanding the transformation of primary care practices to patient-centered medical homes (PCMHs) requires making sense of the change process, multilevel outcomes, and context. We describe the methods used to evaluate the country’s first national demonstration project of the PCMH concept, with an emphasis on the quantitative measures and lessons for multimethod evaluation approaches. METHODS The National Demonstration Project (NDP) was a group-randomized clinical trial of facilitated and self-directed implementation strategies for the PCMH. An independent evaluation team developed an integrated package of quantitative and qualitative methods to evaluate the process and outcomes of the NDP for practices and patients. Data were collected by an ethnographic analyst and a research nurse who visited each practice, and from multiple data sources including a medical record audit, patient and staff surveys, direct observation, interviews, and text review. Analyses aimed to provide real-time feedback to the NDP implementation team and lessons that would be transferable to the larger practice, policy, education, and research communities. RESULTS Real-time analyses and feedback appeared to be helpful to the facilitators. Medical record audits provided data on process-of-care outcomes. Patient surveys contributed important information about patient-rated primary care attributes and patient-centered outcomes. Clinician and staff surveys provided important practice experience and organizational data. Ethnographic observations supplied insights about the process of practice development. Most practices were not able to provide detailed financial information. CONCLUSIONS A multimethod approach is challenging, but feasible and vital to understanding the process and outcome of a practice development process. Additional longitudinal follow-up of NDP practices and their patients is needed.