Table 1

Quantitative PCMH Evaluation Measures: Practice, Clinician, and Staff Survey Instruments

Measurement ToolDomainsSource, Version, Purpose, Availability
Baseline Practice Survey45Demographics and practice informationOriginal NDP questionnaire (96 items). Adapted questionnaire by BPCTI (27 items). Provides information for NCQA and meaningful use. No cost
Supplemental Appendix 1,
PCMH Implementation Survey45,46Change capacity: teamwork, work environment, culture, trust, communicationModified 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,
Practice Demographic Questionnaire for cliniciansDemographics of individual practice cliniciansBPCTI (9 items). For physicians, NPs, and PAs. No cost
Supplemental Appendix 3,
Practice Demographic Questionnaire for staffDemographics of individual practice staffBPCTI (5 items). For nurses, medical assistants, receptionists, and other staff. No cost
Supplemental Appendix 4,
The Clinician Activation Measure assessment (CS-PAM)Clinician support for and beliefs about patient activation and patient self-managementValidated tool from Insignia Health (13 items). Requires purchase of a license
Maslach Burnout Inventory47Measure of burnout: emotional exhaustion, depersonalization, personal accomplishmentMBI-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
  • 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.