@article{12a3fa556f42401ca6d4ab8de15110ff,
title = "Pathways to Medical Home Recognition: A Qualitative Comparative Analysis of the PCMH Transformation Process",
abstract = "Objective: To understand the process of practice transformation by identifying pathways for attaining patient-centered medical home (PCMH) recognition. Data Sources/Study Setting: The CMS Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration was designed to help FQHCs achieve NCQA Level 3 PCMH recognition and improve patient outcomes. We used a stratified random sample of 20 (out of 503) participating sites for this analysis. Study Design: We developed a conceptual model of structural, cultural, and implementation factors affecting PCMH transformation based on literature and initial qualitative interview themes. We then used conventional cross-case analysis, followed by qualitative comparative analysis (QCA), a cross-case method based on Boolean logic algorithms, to systematically identify pathways (i.e., combinations of factors) associated with attaining—or not attaining—Level 3 recognition. Data Collection Methods: Site-level indicators were derived from semistructured interviews with site leaders at two points in time (mid- and late-implementation) and administrative data collected prior to and during the demonstration period. Principal Findings: The QCA results identified five distinct pathways to attaining PCMH recognition and four distinct pathways to not attaining recognition by the end of the demonstration. Across these pathways, one condition (change leader capacity) was common to all pathways for attaining recognition, and another (previous improvement or recognition experience) was absent in all pathways for not attaining recognition. In general, sites could compensate for deficiencies in one factor with capacity in others, but they needed a threshold of strengths in cultural and implementation factors to attain PCMH recognition. Conclusions: Future efforts at primary care transformation should take into account multiple pathways sites may pursue. Sites should be assessed on key cultural and implementation factors, in addition to structural components, in order to differentiate interventions and technical assistance.",
keywords = "Medical home, PCMH recognition, QCA, practice transformation, qualitative comparative analysis",
author = "Peter Mendel and Chen, {Emily K.} and Green, {Harold D.} and Courtney Armstrong and Timbie, {Justin W.} and Kress, {Amii M.} and Friedberg, {Mark W.} and Kahn, {Katherine L.}",
note = "Funding Information: Joint Acknowledgment/Disclosure Statement: Funding for this research was provided by Centers for Medicare & Medicaid Services (Contract HHSM-500-2005-00028I, Task # T0008). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The authors thank the participants in the Federally Qualified Health Center Advanced Primary Care Practice Demonstration who generously shared their experiences and insights throughout the demonstration, the Demonstration's implementation support contractors for their assistance with data collection, and Suzanne Wensky and Katherine Giuriceo from the Center for Medicare and Medicaid Innovation for feedback on earlier versions of this manuscript. The authors also acknowledge Peter Hussey for his role in the design of the evaluation and Kristin Leuschner from RAND for editorial assistance. Disclosure: None. Disclaimer: None. Funding Information: Joint Acknowledgment/Disclosure Statement: Funding for this research was provided by Centers for Medicare & Medicaid Services (Contract HHSM-500-2005-00028I, Task # T0008). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The authors thank the participants in the Federally Qualified Health Center Advanced Primary Care Practice Demonstration who generously shared their experiences and insights throughout the demonstration, the Demonstration{\textquoteright}s implementation support contractors for their assistance with data collection, and Suzanne Wensky and Katherine Giuriceo from the Center for Medicare and Medicaid Innovation for feedback on earlier versions of this manuscript. The authors also acknowledge Peter Hussey for his role in the design of the evaluation and Kristin Leuschner from RAND for editorial assistance. Disclosure: None. Disclaimer: None. Publisher Copyright: {\textcopyright} Health Research and Educational Trust",
year = "2018",
month = aug,
doi = "10.1111/1475-6773.12803",
language = "English (US)",
volume = "53",
pages = "2523--2546",
journal = "Health services research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "4",
}