What are the key elements for implementing intensive primary care? A multisite Veterans Health Administration case study
What are the key elements for implementing intensive primary care? A multisite Veterans Health Administration case study
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DOI：
10.1016/j.hjdsi.2017.10.001
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发表时间：
2018-12-01
影响因子：
2.5
通讯作者：
Asch, Steven M.
中科院分区：
文献类型：
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作者：
Chang, Evelyn T.;Raja, Pushpa, V;Asch, Steven M.
许多综合卫生系统和负责任的护理组织已经转向强化初级保健计划，以提高护理质量，降低高需求高成本患者的成本。如何最好地实施这些方案仍然是一个积极的讨论领域。2014年，退伍军人健康管理局（VHA）实施了五个不同的强化初级保健计划，作为针对住院风险最高的退伍军人的示范项目的一部分。我们发现，随着时间的推移，项目不断发展，最终集中在以下要素的实施上：1）跨学科护理团队，2）慢性病管理，3）全面的患者评估和评价，4）护理和病例管理，5）过渡性护理支持，6）预防性家访，7）药物服务，8）慢性病自我管理，9）护理人员支持服务，10）健康指导，和11）先进的护理计划。研究小组还发现，将社会工作者和心理健康提供者纳入跨学科团队对于有效解决这些复杂患者的心理社会需求至关重要。有一个中央执行协调员促进了这些计划的特点在不同的示范点的融合。在这些计划的未来迭代中，VHA打算标准化人员配置和关键功能，以开发可以在整个系统中传播的可扩展计划。
Many integrated health systems and accountable care organizations have turned to intensive primary care programs to improve quality of care and reduce costs for high-need high-cost patients. How best to implement such programs remains an active area of discussion. In 2014, the Veterans Health Administration (VHA) implemented five distinct intensive primary care programs as part of a demonstration project that targeted Veterans at the highest risk for hospitalization. We found that programs evolved over time, eventually converging on the implementation of the following elements: 1) an interdisciplinary care team, 2) chronic disease management, 3) comprehensive patient assessment and evaluation, 4) care and case management, 5) transitional care support, 6) preventive home visits, 7) pharmaceutical services, 8) chronic disease self-management, 9) caregiver support services, 10) health coaching, and 11) advanced care planning. The teams also found that including social workers and mental health providers on the interdisciplinary teams was critical to effectively address psychosocial needs of these complex patients. Having a central implementation coordinator facilitated the convergence of these program features across diverse demonstration sites. In future iterations of these programs, VHA intends to standardize staffing and key features to develop a scalable program that can be disseminated throughout the system.