Methods for evaluating practice change toward a patient-centered medical home.

Carlos Roberto Jaén, Benjamin F. Crabtree, Raymond F. Palmer, Robert L. Ferrer, Paul A. Nutting, William L. Miller, Elizabeth E. Stewart, Robert Wood, Marivel Davila, Kurt C. Stange

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Original languageEnglish
JournalAnnals of Family Medicine
Volume8 Suppl 1
DOIs
StatePublished - 2010

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Patient-Centered Care
Medical Audit
Medical Records
Primary Health Care
Information Storage and Retrieval
Medical Staff
Research
Randomized Controlled Trials
Nurses
Observation
Interviews
Education

ASJC Scopus subject areas

  • Family Practice

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Methods for evaluating practice change toward a patient-centered medical home. / Jaén, Carlos Roberto; Crabtree, Benjamin F.; Palmer, Raymond F.; Ferrer, Robert L.; Nutting, Paul A.; Miller, William L.; Stewart, Elizabeth E.; Wood, Robert; Davila, Marivel; Stange, Kurt C.

In: Annals of Family Medicine, Vol. 8 Suppl 1, 2010.

Research output: Contribution to journalArticle

Jaén, CR, Crabtree, BF, Palmer, RF, Ferrer, RL, Nutting, PA, Miller, WL, Stewart, EE, Wood, R, Davila, M & Stange, KC 2010, 'Methods for evaluating practice change toward a patient-centered medical home.', Annals of Family Medicine, vol. 8 Suppl 1. https://doi.org/10.1370/afm.1108
Jaén, Carlos Roberto ; Crabtree, Benjamin F. ; Palmer, Raymond F. ; Ferrer, Robert L. ; Nutting, Paul A. ; Miller, William L. ; Stewart, Elizabeth E. ; Wood, Robert ; Davila, Marivel ; Stange, Kurt C. / Methods for evaluating practice change toward a patient-centered medical home. In: Annals of Family Medicine. 2010 ; Vol. 8 Suppl 1.
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title = "Methods for evaluating practice change toward a patient-centered medical home.",
abstract = "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.",
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AU - Jaén, Carlos Roberto

AU - Crabtree, Benjamin F.

AU - Palmer, Raymond F.

AU - Ferrer, Robert L.

AU - Nutting, Paul A.

AU - Miller, William L.

AU - Stewart, Elizabeth E.

AU - Wood, Robert

AU - Davila, Marivel

AU - Stange, Kurt C.

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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.

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.

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