A 55-member national advisory committee (NAC) was utilized to develop the definition of a PCDH through a consensus process. NAC members qualified for selection based on either : 1) their individual expertise in predetermined area of need; and/or 2) as the representative of an organization with particular relevance to the topic of patient-centered care, quality measurement and the integration of oral health care. The predetermined areas about which expertise was sought for this project included:

Members were identified through a purposive sampling process that included snowball sampling techniques. A heterogeneous sample was intended to include individuals with relevant expertise as well as those representing the range of stakeholders involved in implementing and using the PCDH model. Stakeholder and organizational representative recruitment involved identifying individuals and organizations within domains of needed expertise.

Email invitations that included a description of the study and expected time commitment were sent to all identified experts and organizations. Of those who did not respond, reminder emails were sent up to three times over the course of two months. In the case of organizational representatives, the initial contact person generally provided the name of another individual who would be representing the organization. Of 63 individuals/organizations contacted, four declined and four did not respond, for a final sample of 55 participants that formed the NAC for this project.
Delphi studies generally demonstrate a wide range of participant numbers; a larger size is more common when seeking a heterogeneous group.1 Recruitment was not based on a specific sample size target, but rather to ensure that appropriate content expertise and stakeholder representation was achieved.

We used the Agency for Healthcare Research and Quality (AHRQ) patient-centered medical home (PCMH) definition as a starting point to develop the PCDH definition. The AHRQ PCMH definition included the following characteristics: comprehensive, patient-centered, coordinated, accessible, and focused on quality and safety. We added family-centered and continuous based on the inclusion of these characteristics in existing dental home definitions.

The NAC was asked, via a web-based survey, to rate how essential each of the eight characteristics was to the definition of a PCDH. Each characteristic was rated on a scale of 1 to 9, where 1 was “not essential” and 9 was “definitely essential”. Participants were also asked to identify any additional, conceptually distinct characteristics that they thought should be considered by the entire NAC for a final definition of a PCDH. Figure 1 shows the criteria and guidance provided in the Round 1 questionnaire for consideration in making these assessments.
 

1.    Patient-Centered Dental Home Development project: Phase 1 study methodology (2016). Univ of Iowa Research Online. DOI: 10.17077/fwo6-ezo4. Available at: https://iro.uiowa.edu/esploro/outputs/report/Patient-Centered-Dental-Home-development-project-Phase/9983557251902771?institution=01IOWA_INST 

2.    The Patient-Centered Dental Home: A standardized definition for quality assessment, improvement and integration. Health Services Research (2018). Available at: https://doi.org/10.1111/1475-6773.13067