We conducted 20 semi-structured discussions with pediatricians and family physicians between November 2012 and January 2013. To recruit these individuals, we first identified all pediatricians and family physicians in Texas and Colorado who worked at practices that obtained Level 3 NCQA PCMH-recognition prior to 2011 using a data file purchased directly from NCQA. We selected these states in order to conduct a richer analysis in our parallel study using these states' Medicaid claims data to examine relationships between recognition status and service use. NCQA's data file contained name, address, and recognition level and date for all practices that received NCQA's Physician Practice Connections® Patient-Centered Medical HomeTM recognition between November 2008 and October 2011, as well as the name, specialty, and national provider identifier (NPI) of all providers in each practice.
We merged NPIs from this file with 2008 Medicaid Analytic eXtract (MAX) professional claims data14 to identify providers who served Medicaid-covered CSHCN at practices that received recognition before 2011. CSHCN were defined using Medicaid eligibility data (children qualifying on the basis of disability) or by applying the Chronic Illness and Disability Payment System algorithms15 to flag children with chronic health conditions. The resulting sample included 174 pediatricians and family physicians at 52 practices; practices were affiliated with 12 larger parent organizations. The purposive strategy for selecting the subset included in this study aimed to include the physicians who served the most Medicaid-covered CSHCN per practice, and to achieve variation in location and organization affiliation. NCQA sent emails to these physicians endorsing the study. The study team emailed recruitment materials and followed up by telephone until 20 physicians agreed to participate. We contacted 53 physicians. We paid a $500 stipend to the practice of each physician who completed a discussion.
Two investigators (Dana Petersen and Joseph Zickafoose) conducted discussions, with third investigator (Mynti Hossain) audio-recording and taking notes. Discussions were conducted over the telephone and ranged from 20 minutes to 45 minutes in length. Participants received consent documents by email prior to the discussion and provided verbal consent. We used a semi-structured discussion guide and spontaneous verbal probes when additional information or clarification was needed. Prior to the discussion, we emailed each physician a worksheet describing the eight 2008 NCQA PCMH standards. During the discussion, we asked physicians to discuss why their practice sought PCMH-recognition and how obtaining recognition influenced the care they and their practices provided for children, especially CSHCN. We also asked physicians to review the worksheet and comment on changes their practices made related to each standard.
This study was approved by the New England Institutional Review Board.