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Evidence and Evaluation

About the Evidence:

Policy decisions concerning the PCMH must rest on sound evidence about whether this model of care helps achieve the Triple Aim of improved patient outcomes, improved patient experience, and improved value. In this section, explore information and resources for PCMH researchers, evaluators, and decision makers. 


PCMH Research Methods Series 

The PCMH Research Methods Series was commissioned by AHRQ and developed under contract by Mathematica Policy Research, with input from other nationally recognized thought leaders in research methods and PCMH models. The series is designed to “expand the toolbox” of methods used to evaluate and refine PCMH models and other health care interventions. This toolbox of novel and underused methods can equip evaluators and implementers to better assess and refine PCMH models and to meet the evidence needs of PCMH stakeholders more effectively. Each of the briefs describes a method and how PCMH researchers have used it or could do so, discusses advantages and limitations of the methods, and provides resources for researchers to learn more about the method.

Title Brief Description PDF HTML

Expanding the Toolbox: Methods to Study and Refine Patient-Centered Medical Home Models

Debbie Peikes, Dana Petersen, Aparajita Zutshi, David Meyers, Janice Genevro

This overview provides an introduction to the PCMH Research Methods Series and introduces methods or approaches that have the potential to expand and refine understanding of the PCMH as a complex health care intervention and innovation. (PDF - 813.06 KB)
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Anthropological Approaches

Roberta E. Goldman and Jeffrey Borkan

Anthropology explores human culture, behavior, and expression using an ethnographic approach, which employs multiple methods of data collection to construct a holistic and contextual view of the phenomena under study. It excels in uncovering unexpected insights by studying a topic in person, in situ, over time, and from diverse perspectives.

(PDF - 2386.48 KB)

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Cognitive Task Analysis

Georges Potworowski and Lee A. Green

 

Cognitive task analysis (CTA) is a family of methods designed to reveal the thinking involved in performing tasks in real-world contexts. CTA can be used to uncover and describe key patterns, variations, opportunities for improvement, and leverage the “knowledge work”—not just the physical work—of primary care staff and clinicians implementing PCMH models.

(PDF - 2068.48 KB)

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Contextual Factors: The Importance of Considering and Reporting on Context in Research on the Patient-Centered Medical Home

Kurt C. Stange and Russell E. Glasgow
Health care and health are complex systems that are fundamentally context-dependent. What works in one context often does not work in another, which can lead to conflicting or inconsistent findings. It is important to attend to and describe contextual factors in designing, conducting, and reporting research on PCMH models.

(PDF - 403 KB)  

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Efficient Orthogonal Designs

Jelena Zurovac, Deborah Peikes, Aparajita Zutshi, and Randy Brown

Efficient orthogonal design is a tool that must be used at the outset of a study that can be used to compare the effectiveness of different ways of deploying each component of a PCMH, as well as how the effects of individual components interact with one another. 

(PDF - 1433.6 KB)

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Formative Evaluation

Kristin Geonnotti, Deborah Peikes, Winnie Wang, and Jeffrey Smith

Formative evaluations provide ongoing, concrete feedback to PCMH implementers and other stakeholders on whether a model is being delivered as planned or is having the intended effects, so staff can modify the intervention as it unfolds.

(PDF - 813.06 KB)

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Fuzzy-Set Qualitative Comparative Analysis and Configurational Comparative Methods

Marcus Thygeson, Deborah Peikes, Aparajita Zutshi

Qualitative comparative analysis is a tool for linking implementation and impact findings that distills different constellations of factors associated with successful and unsuccessful outcomes.

(PDF - 1024 KB)

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Implementation Research

Laura Damschroder, Deborah Peikes, and Dana Petersen

Implementation research focuses on understanding how programs are executed, translated, replicated, and disseminated in real-world settings. It expands the focus of traditional research from discovering what works to also discovering how the program works in specific contexts.

(PDF - 1208.32 KB)

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Mixed Methods

Jennifer Wisdom and John Creswell

Mixed-methods studies systematically integrate, or "mix," quantitative and qualitative data to improve our understanding of implementation and impact findings.

(PDF - 1126.40 KB)

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Optimal Use of Logic Models

Dana Petersen, Erin Fries Taylor, and Deborah Peikes

A logic model - also known as a program model, theory of change, or theory of action - is a graphic illustration of how a program of intervention is expected to produce desired outcomes. Logic models are not only useful for guiding data collection activities, but they are also valuable planning tools for developing strong interventions.

(PDF - 731 KB)

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Pragmatic Clinical Trials

Deborah Peikes, Kristin Geonnotti, and Winnie Wang

Pragmatic clinical trials (PCTs) are randomized controlled trials designed to test effectiveness in real world settings and meet the needs of stakeholders deciding whether to adopt a PCMH. In PCTs, researcher test PCMH models in typical practices and on typical patients, and evaluate a comprehensive set of outcomes related to quality, cost, and patient and provider experience. Researchers combine implementation and impact findings to distill the best approaches to a PCMH in different settings.

(PDF - 1638.4 KB)

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Statistical Process Control

Jill A. Marsteller, Mary Margaret Huizinga, and Lisa A. Cooper

Statistical process control is used to detect changes in process or outcome variables that are measured frequently over time. The findings are then depicted graphically to yield quick insights into the data and present them to stakeholders in a user-friendly manner.

(PDF - 733 KB)

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Webinars on Methods in Delivery System Research

Explore slide presentations from past webinars on advanced methods in delivery system research. The webinars were sponsored by AHRQ's Delivery System Initiative in partnership with the AHRQ PCMH program, and they include some of the following topics:

  • Fuzzy Set Analysis
  • Statistical Process Control
  • Logic Models
  • Formative Evaluation
  • Mixed Methods

 

PCMH Papers and Briefs

Explore AHRQ’s papers and briefs on designing strong evaluations and developing the evidence base for the medical home model.

Title Brief Description PDF HTML
Building the Evidence Base for the Medical Home: What Sample and Sample Size Do Studies Need? Evaluations of the medical home should account for clustering of patients within practices. This paper describes why and how to do this and what samples of patients and practices are needed for studies to achieve adequate statistical power. (PDF-368.48KB)
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Improving Evaluations of the Medical Home A concise description for decisionmakers of why and how to commission effective evaluations of medical home demonstrations. Learn what outcomes to assess, why to include control practices, and why not accounting for clustering can doom an evaluation. (PDF-88.66KB)
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Early Evidence on Patient-Centered Medical Home The patient-centered medical home (PCMH, or medical home) aims to reinvigorate primary care and achieve the triple aim of better quality, lower costs, and improved experience of care. This study systematically reviews the early evidence on effectiveness of the PCMH. (PDF-201.18KB)
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The Medical Home: What Do We Know, What Do We Need to Know?: A Review of the Current State of the Evidence on the Effects of the Patient Centered Medical Home Model Amid burgeoning efforts to create medical homes across the U.S., this paper describes the evidence we have so far on the effects of precursors to the medical home model on key outcomes, and how to improve studies in the future. (PDF-1 MB) 
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Evaluation Tools

Explore resources designed to assist researchers in evaluating care coordination and consumer experience, two crucial elements of the medical home.

Evaluation Tools Brief Description PDF HTML
Care Coordination Measure Atlas This resource lists existing measures of care coordination, with a focus on ambulatory care, and presents a framework for understanding care coordination measurement. The Atlas is useful for evaluators of projects aimed at improving care coordination and for quality improvement practitioners and researchers studying care coordination. (PDF-2.2MB)
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PCMH-CAHPS The Consumer Assessment of Healthcare Providers and Systems (CAHPS) program develops and supports the use of a comprehensive and evolving family of standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care.   HTML



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