After slightly more than 2 years, implementation of PCMH components, whether by facilitation or practice self-direction, was associated with small improvements in condition-specific quality of care but not patient experience. PCMH models that call for practice change without altering the broader delivery system may not achieve their intended results, at least in the short term.

PURPOSE Understanding the transformation of primary care practices to patientcentered medical homes (PCMHs) requires making sense of the change process, multilevel outcomes, and context. We describe the methods used to evaluate the country's fi rst national demonstration project of the PCMH concept, with an emphasis on the quantitative measures and lessons for multimethod evaluation approaches. METHODSThe National Demonstration Project (NDP) was a group-randomized clinical trial of facilitated and self-directed implementation strategies for the PCMH. An independent evaluation team developed an integrated package of quantitative and qualitative methods to evaluate the process and outcomes of the NDP for practices and patients. Data were collected by an ethnographic analyst and a research nurse who visited each practice, and from multiple data sources including a medical record audit, patient and staff surveys, direct observation, interviews, and text review. Analyses aimed to provide real-time feedback to the NDP implementation team and lessons that would be transferable to the larger practice, policy, education, and research communities.RESULTS Real-time analyses and feedback appeared to be helpful to the facilitators. Medical record audits provided data on process-of-care outcomes. Patient surveys contributed important information about patient-rated primary care attributes and patient-centered outcomes. Clinician and staff surveys provided important practice experience and organizational data. Ethnographic observations supplied insights about the process of practice development. Most practices were not able to provide detailed fi nancial information.CONCLUSIONS A multimethod approach is challenging, but feasible and vital to understanding the process and outcome of a practice development process. Additional longitudinal follow-up of NDP practices and their patients is needed.Ann Fam Med 2010;8(Suppl 1):s9-s20. doi:10.1370/afm.1108. INTRODUCTIONT he 2004 Future of Family Medicine report documented the current crisis in the US health care system and made the case for a "New Model" of practice.1,2 This model has evolved to be consistent with the emerging consensus principles of the patient-centered medical home (PCMH). 3 The PCMH model of primary care incorporates current best practices in terms of access to care, prevention, chronic disease management, care coordination, and responsiveness to patients. [4][5][6][7][8][9][10][11][12][13][14] This model also acknowledges the trend toward health care consumerism and seeks to leverage information technology to improve outcomes and communication. 15 In June 2006, the American Academy of Family Physicians (AAFP) began a trial to implement the PCMH model in 36 volunteer practices over the course of 2 years. The AAFP contracted with the Center for Research in Family Medicine and Primary Care to conduct an independent evaluation. This article describes the key methodologic strategies used for the evaluation and includes a comprehensive list of the data colCarlos ...

Higher acculturation, pregnancy and single status were positively associated with elevated depressive symptoms. Screening for depression during pregnancy is important for this population group, given Latinas' high rates of fertility and births to single women, particularly among more acculturated, U.S.-born Latinas.

Objective. This study examines the association of social ties and cancer screening. Method. Data from the Longitudinal Study on Aging II include 4,419 respondents (70 to 85) who completed Wave 2. The dependent variable is receipt of screening within the past 2 years, measured at Wave 2. Social network variables include marital status, interaction with friends, relatives, and children, and church attendance. Results. Women were higher on most social tie measures, except marriage, and less likely to have mammography than men were to have prostate cancer screening. Also, the decline of screening with age was greater for women. For women, screening was related to contact with friends, relatives, and children but not marital status or church attendance. For men, screening was higher in the married and church attendees, but contact with friends, relatives, and children was not associated with screening. Discussion. Cancer screening interventions that use interpersonal communication channels should target distinct relationships for older women and men

It remains unclear when the fetus is most susceptible to the effects of particulate air pollution. We conducted a population-based study in a large urban area to evaluate associations between preterm birth (PTB) and fetal growth and exposures to fine particles (PM2.5) during narrow periods of gestation. We identified 177,816 births during 2005–2007 among mothers who resided in Harris County, Texas at the time of delivery. We created three mutually exclusive categories of mildly (33–36 completed weeks of gestation), moderately (29–32 weeks of gestation), and severely (20–28 weeks of gestation) PTB, and among full term infants, we identified those who were born small for their gestational age. Using routine air monitoring data, we generated county-level daily time series of estimated ambient air levels of PM2.5 and then computed exposure metrics during every 4 weeks of a mother’s pregnancy. We evaluated associations in each 4-week period using multiple logistic regression. A 10 μg/m3 increase in PM2.5 exposure in the first 4 weeks of pregnancy significantly increased the odds of mildly, moderately and severely PTB by 16, 71 and 73 %, respectively. Associations were stronger when infants with birth defects were excluded. Our findings indicate an association between PM2.5 and PTB, with stronger associations for moderately and severely PTB infants. Efforts should continue to implement stricter air quality standards and improve ambient air quality.