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.

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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 ...

Food insecurity is common in the United States and linked to poor control of conditions influenced by diet. We conducted a pilot randomized trial to test whether a novel partnership between a primary care practice and a municipal food bank would improve control of type 2 diabetes among patients with food insecurity. Participants received food bank produce delivered twice monthly to the practice site, brief teaching from a food bank dietitian, and home-based education from a community health worker. After 6 months, glycosylated hemoglobin decreased (absolute change) by 3.1% in the intervention group vs 1.7% in the control group ( P = .012). Scores on Starting the Conversation–Diet, a brief dietary measure, improved in the intervention group by 2.47 on a 14-point scale ( P < .001). Body mass indexes (BMIs) were unchanged. In this early-stage study, onsite collaboration between primary care and a regional food bank generated clinically meaningful reductions in HbA1c and improvements in diet.