Building a conceptual model of a primary care system – an iterative systems thinking approach

Patient Centered Medical Home (PCMH) analysis to date has been focused on outcomes. Less emphasis has been placed on how these transformations occurred and how PCMH works in practice. This work provides a holistic qualitative understanding of our system's PCMH as experienced by those working within it – the PCMH components, their interactions and emergent behavior – an understanding, which can ultimately yield insights to guide efficient and successful transformation of health care delivery systems. Using a systems thinking approach, the perspectives of University of Utah Community Clinics (UUCC) providers, medical assistants (MAs), and management are explored and integrated into a portrait of Care By Design (CBD), the UUCC's version of the PCMH. Semi-structured interviews (conducted in 2011, n=82) with employees implementing CBD within the UUCCs were thematically coded to explore each respondent's perception of the healthcare delivery system, identifying system components and tensions between them. Causal loop diagrams (CLDs) illustrating each participant's view of CBD – its elements, relationships, and feedback loops – were created based upon the thematic coding. CLDs were analyzed to identify the most prevalent components, feedback loops and time delays identified by informants in implementing the UUCC's version of the PCMH. One overarching conceptual model for the UUCC PCMH was created by integrating these CLDs. Verification of the conceptual model was performed via discussion with key informants. The poster will present the overarching conceptual model obtained as well as observed variation in the most prevalent components, feedback loops and time delays identified in individual CLDs.