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.
Administration, management, leadership
Chronic disease management and prevention
Provision of health care to the public
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health
Define the complex system redesign that is the patient centered medical home (PCMH).
List the main tensions, feedback loops, and time delays involved.
Articulate the composition of those feedback loops.
Keyword(s): Primary Care, Management
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I am a Public Health PhD candidate at the London School of Hygiene and Tropical Medicine presenting dissertation results. My committee consists of experts in systems thinking, system dynamics, statistics, primary care, and health systems as well as medical doctors and administrators within the system that I am studying. This work is funded by grants from AHRQ as well as HHS (see external funding section above) â I am a Research Associate on these grants.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.