Core Functions and Forms of Complex Health Interventions: a Patient-Centered Medical Home Illustration
Core Functions and Forms of Complex Health Interventions: a Patient-Centered Medical Home Illustration
复制标题
DOI：
10.1007/s11606-018-4818-7
复制
发表时间：
2019-06-01
影响因子：
5.7
通讯作者：
Mittman, Brian S.
中科院分区：
文献类型：
--
作者：
Jolles, Monica Perez;Lengnick-Hall, Rebecca;Mittman, Brian S.
尽管政策和实践支持开发和测试旨在增加高需求患者获得优质护理的干预措施，但这些干预措施中的许多措施一旦部署在现实生活中的临床环境中，就无法达到预期。一个例子是以病人为中心的医疗之家（PCMH）模式，旨在提供协调的护理。对PCMH举措的荟萃分析发现，对服务获取、质量和成本的影响证据不一。将PCMH概念化为一种复杂的健康干预措施，可以深入了解该模型实现其效果的机制。它还可以通过区分PCMH核心功能（干预的基本目的）与形式（用于满足每个功能的策略）来解决异质性。我们进行了范围审查，以确定2007年至2017年已发布的PCMH模型中记录的核心功能和形式。我们分析和总结数据，以开发一个PCMH功能和形式矩阵。该矩阵有助于发展一个明确的理论为基础的描述如何干预实现其效果，并可以指导决策支持工具在外地。这种创新方法可以通过对干预措施的标准核心功能和适应当地环境特征的形式的清晰理解来支持临床环境和实施工作的转变。
Despite policy and practice support to develop and test interventions designed to increase access to quality care among high-need patients, many of these interventions fail to meet expectations once deployed in real-life clinical settings. One example is the Patient-Centered Medical Home (PCMH) model, designed to deliver coordinated care. A meta-analysis of PCMH initiatives found mixed evidence of impacts on service access, quality, and costs. Conceptualizing PCMH as a complex health intervention can generate insights into the mechanisms by which this model achieves its effects. It can also address heterogeneity by distinguishing PCMH core functions (the intervention's basic purposes) from forms (the strategies used to meet each function). We conducted a scoping review to identify core functions and forms documented in published PCMH models from 2007 to 2017. We analyzed and summarized the data to develop a PCMH Function and Form Matrix. The matrix contributes to the development of anexplicit theory-based depiction of how an intervention achieves its effects, and can guide decision-support tools in the field. This innovative approach can support transformations of clinical settings and implementation efforts by building on a clear understanding of the intervention's standard core functions and the forms adapted to local contexts' characteristics.