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

March 2013
AHRQ Publication No. 13-0012-EF
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/
Overview of the 12 interventions reviewed and the sources that describe the interventions and evaluations
Topic and AuthorsSummaryMonthly Savings
ImplementationImpactSynthesis
Anthropological Approaches
Roberta E. Goldman and Jeffrey Borkan
Anthropology explores the whys and hows of human culture, behavior, and expression using ethnographic methods. It excels in uncovering unexpected insights by studying a topic in person, in situ, over time, and from diverse perspectives. The ethnographic method uses multiple methods of data collection to construct a holistic and contextual view of the phenomena under study.X  
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 methods 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.X  
Efficient Orthogonal Designs
Jelena Zurovac, Deborah Peikes, Aparajita Zutshi, and Randy Brown
Efficient orthogonal designs can compare the effectiveness of different ways of deploying each component of a PCMH. XX
Formative Evaluation
Kristin Geonnotti, Deborah Peikes, Winnie Wang, and Jeffrey Smith
Formative evaluations provide ongoing, concrete feedback to PCMH implementers and other stakeholders to identify when the model is not being delivered as planned or not having the intended effects, so they can modify the intervention as it unfolds.XX 
Fuzzy-Set Qualitative Comparative Analysis and Configurational Comparative Methods
Marcus Thygeson, Deborah Peikes, Aparajita Zutshi
Qualitative comparative analysis is an invaluable tool to link implementation and impact findings. It distills different constellations of factors associated with successful and unsuccessful outcomes.  X
Implementation Research
Laura Damschroder, Deborah Peikes, and Dana Petersen
Implementation research focuses on understanding how programs are implemented, translated, replicated, and disseminated in “real world” settings. It expands the focus of traditional research from discovering what works to also discovering how the implementation works in specific contexts.X  
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.XX 
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 or intervention is expected to produce desired outcomes. Logic models are not only useful evaluation tools that guide data collection activities, but also valuable planning tools that can help develop strong interventions.XX 
Pragmatic Clinical Trials
Deborah Peikes, Kristin Geonnotti, and Winnie Wang
Pragmatic clinical trials (PCTs) are randomized, controlled trials that better meet the needs of decisionmakers regarding adoption of a PCMH. PCTs test PCMH models in typical practices and on typical patients; evaluate a comprehensive set of quality, cost, and patient and provider experience outcomes; study the intervention as each practice adapts it to fit its own context, and refines it over time; and combine implementation and impact findings to distill the best approaches to a PCMH in different settings. X 
Statistical Process Control
Jill A. Marsteller, Mary Margaret Huizinga, and Lisa A. Cooper
Statistical process control detects changes in process or outcome variables that are measured frequently over time and depicts them using graphical representation; thus, it can yield insights into data more quickly and in a more understandable manner for stakeholders.XXX