Expanding the Toolbox: Methods to Study and Refine Patient- Centered Medical Home Models
Prepared For: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850, http://www.ahrq.gov/
The patient-centered medical home (PCMH) is a promising primary care approach that emphasizes patient-centered, comprehensive, coordinated, accessible care, with a systematic focus on quality and safety. The goal of these models is to improve quality, cost, and patient and provider experience.
The Agency for Healthcare Research and Quality (AHRQ) recognizes that revitalizing primary care is key to achieving high quality, accessible, and efficient health care for all Americans, and that improving the research infrastructure will equip evaluators across the country to provide information that will help shape PCMH models to achieve those aims. To do so, PCMH evaluations must generate evidence that stakeholders (including patients, payers, providers, and employers) can use to improve primary care. This requires both understanding the different evidentiary needs of stakeholders and using the right tools to meet those needs.
To help evaluators and researchers produce robust evidence that can be used to improve primary care, AHRQ conceptualized and commissioned a series of briefs to expand the toolbox of methods to evaluate and help refine PCMH models and other primary care delivery interventions. The series was co-edited by Debbie Peikes, Dana Petersen, and Aparajita Zutshi of Mathematica Policy Research 1, and David Meyers and Janice Genevro of AHRQ.
Our interest in improving methods for studying PCMH models and other practice-level innovations began when we conducted a review of the current evidence on PCMHs (Peikes et al., 2012a, 2012b). At the time, we and many thought leaders, providers, and researchers had concerns about the adequacy of traditional methods for evaluating PCMH models.
Like many health care delivery system interventions, PCMHs are particularly challenging to evaluate. The challenges include: (1) describing the changes implemented, (2) identifying barriers and facilitators to implementation, (3) accounting for the practice- and health care system-level contextual factors, (4) shortening the time frame needed for large-scale evaluations, (5) deciding when randomly assigning practices to become a PCMH model is viable, (6) drawing accurate conclusions from small samples, (7) integrating qualitative and quantitative findings from implementation and impact evaluations, and (8) analyzing the findings to determine whether an intervention worked and what factors contributed to its success.
With these challenges in mind, we invited nationally recognized thought leaders in research methods and PCMH models to prepare briefs that describe various methods and approaches and how they might be used to study and refine PCMH models. The topics cover both “evolutionary” ways to improve evaluations—by using traditional health services research methods—and “revolutionary” approaches that draw on novel methods from other fields such as anthropology, organizational analysis, engineering, and political science. Our goal is to ensure that evaluations focus on answering not only “Does it work?” but also “ How does it work?”
The table lists the topics and authors of the briefs, provides summaries of the content, and indicates whether the approaches are suitable for implementation or impact analyses, or for a synthesis of the two.
Each brief introduces a method or approach and discusses some ways in which PCMH researchers have used it or could do so. The briefs then discuss advantages and limitations of the method, and provide resources for researchers to learn more about the method. The table below lists the topics and authors of the briefs, provides summaries of the content, and indicates whether the approaches are suitable for implementation or impact analyses, or for a synthesis of the two.
We hope these methods briefs will spur discussion, provide inspiration, and serve as valuable resources for evaluators and funders of interventions to improve primary care across the country. We believe that an expanded toolbox can help guide refinements to PCMH models, to best enhance primary care delivery and ultimately quality, cost, and patient and provider experience.
- Peikes D, Zutshi A, Genevro J, et al. Early Evidence on the Patient-Centered Medical Home. Final Report (Prepared by Mathematica Policy Research, under Contract Nos. HHSA290200900019I/ HHSA29032002T and HHSA290200900019I/HHSA29032005T). Rockville, MD: Agency for Healthcare Research and Quality; February 2012a. AHRQ Publication No. 12-0020-EF.
- Peikes, D, Zutshi A, Genevro J, et al. Early evaluations of the medical home: building on a promising start. Am J Manag Care 2012b;18(2):105-16.
- The work of Mathematica Policy Research on this project was funded under contract number HHSA290200900019I from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.