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

June 2013
AHRQ Publication No. 13-0045-EF
Prepared For:
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850,
Frameworks and Examples of Domains to Consider as Relevant Context
FrameworkExamples of Domains to Consider as Relevant Context
Definitional models of the
PCMH 1, 7-13
The fundamental tenets of primary care (access, comprehensiveness, integration/coordination, relationship), new ways of organizing and paying for care
The Practice Change Model 14, 15Internal and external motivation for change, capability for development, stakeholder-perceived options for development
The Primary Care Practice
Development Model 15, 16
Development process in practices’ core (key resources, organizational structure, functional processes), adaptive reserve
(features that enhance resilience, such as relationships), and attentiveness to the local environment
The Multilevel Change Model 17Considering at least three levels of influence (e.g., patient/family systems; health care micro system; and larger organization,
community, or policy)
The Model for Understanding
Success in Quality 18, 19
Identifies 25 contextual factors likely to influence quality improvement success. Factors within microsystems and the QI
team are hypothesized to directly shape QI success; factors within the organization and external environment are hypothesized to
indirectly influence success.
The Expanded 20  Chronic Care
Model 21-23 and the Health
Literate Care Model 24
System design, information systems, decision support, self-management support, system and community resources and
policies, community and practice activation and relationships
The RE-AIM framework 25-27Factors that influence the reach, effectiveness, adoption, implementation, and maintenance of a PCMH intervention and
for subgroups of stakeholders
The Evidence Integration
Triangle 28
Practical evidence-based intervention components, pragmatic, longitudinal measures of progress, participatory implementation
processes, active engagement of key stakeholders
Community-Based Participatory
Research Conceptual Model 29, 30
Relationships between: group dynamics, extent of community-centeredness in approach, impact of participatory processes on
system change, and health outcomes
Patient Safety Practice domains 31Safety culture, teamwork and leadership involvement; structural organizational characteristics; external factors; availability of
implementation and management tools
Behavioral Model of
Utilization 32
Environmental and provider-related variables
Methods for exploring
implementation variation 33
Density of inter-organizational ties at the start of the intervention, centrality of the primary care agencies expected to take a lead,
extent of context-level adaptation of the intervention, amount of local resources contributed by the participating agencies