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(19,23) As a starting point for the PCDH definition, we adopted the AHRQ's PCMH definition, which includes the following characteristics: (a) comprehensive, (b) patient-centered, (c) coordinated, (d) accessible, and focused on (e) quality and (f) safety.
The NAC members were asked, via a web-based survey, to rate how essential each of the eight characteristics was to the definition of a PCDH. For each round, NAC members had 3 weeks to respond to the questionnaire, with an advance email notification and instructions followed by two reminders.
(17,27) In the first round, we also asked participants to identify any additional, conceptually distinct characteristics that they believed should be considered for inclusion in a PCDH definition.
After finalizing the PCDH definition through the Delphi process, a report describing the development process, including the finalized PCDH definition, was posted online on March 15, 2016, for a 1-month public comment period, with email dissemination to relevant listservs of key organizational stakeholders (e.g., Dental Public Health listserv, Dental Quality Alliance listserv, and DentaQuest listserv).
All eight characteristics in the Round 1 survey received a median rating of 7-9 without disagreement (Table 2); therefore, all eight characteristics were retained as part of the PCDH definition In subsequent rounds.
Based on these two Delphi rating rounds, a PCDH definition and report were developed for public comment.
Eighteen sources, including individuals and national organizations, provided feedback for the proposed PCDH definition during the month-long public comment period.
Greater clarity was needed to emphasize that part of the goal of the PCDH is to facilitate integration of dental care within health home models of care with applicability to a wide range of settings and populations.
Consequently, two proposed changes to the PCDH definition were evaluated in a third Delphi round by the NAC:
Adding a clause to specify that the PCDH is part of a health home and Includes populations of all ages, and
The PCDH definition was thus finalized as follows: "The patient-centered dental home is a model of care that is accessible, comprehensive, continuous, coordinated, patient- and family-centered, and focused on quality and safety as an integrated part of a health home for people throughout the life span." Integration as part of a health home was incorporated to reinforce the growing recognition of the need to incorporate oral health into the concept of the broader health home.
This project successfully used a modified Delphi process with a large interdisciplinary group of national experts to develop a standardized definition of a PCDH model of care.