Background: The patient-centered medical home (PCMH) has become a widely cited solution to the deficiencies in primary care delivery in the United States. To achieve the magnitude of change being called for in primary care, quality improvement interventions must focus on whole-system redesign, and not just isolated parts of medical practices.
Methods: Investigators participating in 9 different evaluations of Patient Centered Medical Home implementation shared experiences, methodological strategies, and evaluation challenges for evaluating primary care practice redesign.
Results: A year-long iterative process of sharing and reflecting on experiences produced consensus on 7 recommendations for future PCMH evaluations: (1) look critically at models being implemented and identify aspects requiring modification; (2) include embedded qualitative and quantitative data collection to detail the implementation process; (3) capture details concerning how different PCMH components interact with one another over time; (4) understand and describe how and why physician and staff roles do, or do not evolve; (5) identify the effectiveness of individual PCMH components and how they are used; (6) capture how primary care practices interface with other entities such as specialists, hospitals, and referral services; and (7) measure resources required for initiating and sustaining innovations.
Conclusions: Broad-based longitudinal, mixed-methods designs that provide for shared learning among practice participants, program implementers, and evaluators are necessary to evaluate the novelty and promise of the PCMH model. All PCMH evaluations should as comprehensive as possible, and at a minimum should include a combination of brief observations and targeted qualitative interviews along with quantitative measures.
From the *Department of Family Medicine, Robert Wood Johnson Medical School, Somerset, NJ; †Department of Epidemiology, UMDNJ School of Public Health, Cancer Institute of New Jersey, Somerset, NJ; ‡University of Michigan Health System, Medical Management Center, Ann Arbor, MI; §Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ¶Department of Anthropology, History and Social Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA; ∥Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA; **University of Connecticut Health Center, The Ethel Donaghue Center for Translating Research into Practice and Policy, Farmington, CT; Departments of ††Family Medicine and ‡‡Pediatrics and Human Development, Michigan State University, East Lansing, MI; §§Institute for Health Policy, Muskie School of Public Service, University of Southern Maine, Portland, ME; ¶¶Department of Medicine; University of Chicago, Chicago, IL; ∥∥Center for Research Strategies, Denver, CO; ***Department of Family Medicine, University of Colorado Health Sciences Center, Denver, CO; †††Department of Family and Community Medicine, Lehigh Valley Health Network, Allentown, PA; and Departments of ‡‡‡Family & Community Medicine and §§§Epidemiology & Biostatistics, University of Texas Health Science Center, San Antonio, TX.
Supported by a grant from the Commonwealth Fund.
Reprints: Benjamin F. Crabtree, PhD, Department of Family Medicine, Robert Wood Johnson Medical School, 1 Worlds Fair Drive, Somerset, NJ 08873. E-mail: Crabtrbf@umdnj.edu.