Purpose
Beginning in June 2006, TransforMED will launch a 24-month “proof-of-concept” National Demonstration Project (NDP) to rigorously pilot test the TransforMED Model of Care in 36 family medicine practices across the country.
The goal of the project is to determine empirically the model’s applicability and impact on quality of care and business performance. The project will seek to identify the most efficient and effective way to implement transformative practice redesign as well as potential unintended consequences.
The hypothesis is that the TransforMED Model of Care will improve patient care, patient satisfaction, physician satisfaction and business performance. Additionally, it is hypothesized that facilitated practice redesign whereby practices receive tailored consultation and support from experts in the area of redesign and change management will result in better outcomes than self-directed transformation.
Knowledge gained from this project will inform the practice transformation services that will subsequently be offered by TransforMED to family medicine practices across the country seeking to better meet the needs of patients in a changing health care environment. This information will also contribute to the literature, and policy and practice work on health care improvement.
Practice Selection
The Center for Research in Family Medicine and Primary Care, an independent research group based out of Case Western Reserve University, has been engaged by TransforMED to oversee the evaluation of the National Demonstration Project. The TransforMED Technical Advisory Committee (TAC) selected 36 family medicine practices from a total of 538 applications, 337 of which were complete and considered by the TAC. The 36 pilot projects include a wide variety of practice types and sizes, reflective of the diversity in family medicine practices across the country. Practices were selected to maximize diversity in a number of areas, including practice size, age, location, patient population, ownership, arrangement, revenue and degree to which the practice may have already implemented components of the TransforMED Model of Care. All practices chosen to participate demonstrated a commitment to transformative practice change and collaborative learning. Additionally, the selection process also attempted to identify geographic clusters of practices that met the aforementioned criteria to facilitate group learning.
Methods
The National Demonstration Project evaluation will involve a rigorous multi-method assessment of the process of practice change, using a combination of quantitative and qualitative data collection and analysis techniques, and outcome assessments using surveys and chart audits.
The 36 practices selected to participate in the Project will be randomized into two groups – 18 practices will undergo facilitated implementation of the TransforMED model; 18 practices will undergo self-directed implementation. Both groups will be compared to a control group not engaged in implementing the TransforMED model.
All demonstration practices will undergo an in-depth practice assessment to determine baseline conditions.
Facilitated practices will subsequently receive support from TransforMED in the form of tailored implementation strategies, discounted software technology, training, support and ongoing consultation for the duration of the project from experts in the areas of practice economics, health information technology, practice management and quality improvement. A lead physician and an administrative or clinical support staff member from each practice will participate in periodic meetings and conference calls, and a dedicated e-mail discussion group and Web site will be created to provide a forum for collaboration between the practices. Participants will be encouraged to share best practices with other NDP participants.
The self-directed practices will be evaluated by the same team and according to the same guidelines but will receive no additional intervention. They will be provided access to practice improvement tools and services. The goal is to evaluate if highly motivated, high-quality practices can transition to the TransforMED Model and see the same improvements without facilitation.
Measures
Metrics for evaluation of the project will include patient satisfaction, physician and staff satisfaction, clinical process and outcome measures, and the potential economic impact on practice revenues and physician income.
Process and outcome data will be gathered in both the facilitated and the self-directed practices by a research nurse conducting medical record reviews, patient and staff surveys and direct observation. The facilitator for practices participating in the facilitated group will collect additional data on the process of change.
Outcomes will be evaluated based on nationally recognized metrics, including measures developed by the Ambulatory Quality Alliance, Nursing Care Quality Initiative, Institute for Healthcare Improvement, Medical Group Management Association and the American Medical Association.
Analyses will use a case study approach to elucidate the process of practice change and to identify actionable factors affecting the transformation process. Patient outcomes to be assessed include the quality of chronic disease management, preventive service delivery, acute illness care and mental health care, patient satisfaction and patient-centeredness of care. Practice outcomes include clinician and staff quality of life, practice processes and financial viability.
Results
Key learnings will be synthesized and disseminated on an on-going basis among the demonstration sites and within the larger practice community.
Following the conclusion of the pilot project, the evaluation team will conduct an intensive analysis of the results, summarizing and synthesizing the insights gleaned from the implementation.
Key findings on the process and outcomes will be submitted for publication in the peer-reviewed literature. The Center for Research in Family Medicine and Primary Care has the authority to independently publish both positive and negative findings from this project. A final report is expected in early 2009.
