TY - JOUR
KW - Analysis of Variance
KW - Attitude of Health Personnel
KW - Factor Analysis, Statistical
KW - Health Services Research/economics/methods
KW - Humans
KW - Models, Organizational
KW - Organizational Innovation
KW - Outcome and Process Assessment (Health Care)/economics/methods
KW - Patient-Centered Care/methods/standards/trends
KW - Program Development/economics/methods
KW - Quality Assurance, Health Care/methods
KW - Randomized Controlled Trials as Topic
AU - C. R. Jaen
AU - B. F. Crabtree
AU - R. F. Palmer
AU - R. L. Ferrer
AU - P. A. Nutting
AU - W. L. Miller
AU - E. E. Stewart
AU - R. Wood
AU - M. Davila
AU - K. C. Stange
A1 - 
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.
BT - Annals of family medicine
C5 - Medical Home
CY - United States
DO - 10.1370/afm.1108
JF - Annals of family medicine
N2 - 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.
PP - United States
PY - 2010
SN - 1544-1717; 1544-1709
EP - 20; S92
EP - S9+
T1 - Methods for evaluating practice change toward a patient-centered medical home
T2 - Annals of family medicine
TI - Methods for evaluating practice change toward a patient-centered medical home
U1 - Medical Home
U2 - 20530398
U3 - 10.1370/afm.1108
VL - 8 Suppl 1
VO - 1544-1717; 1544-1709
Y1 - 2010
ER -