VA Experience in Implementing Patient-Centered Medical Home Using a Breakthrough Series Collaborative
VA Experience in Implementing Patient-Centered Medical Home Using a Breakthrough Series Collaborative
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DOI：
10.1007/s11606-014-2773-5
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发表时间：
2014-07-01
影响因子：
5.7
通讯作者：
Boushon, Barbara
中科院分区：
文献类型：
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作者：
Bidassie, Balmatee;Davies, Michael L.;Boushon, Barbara
退伍军人健康管理局（VHA）旨在改善以患者为中心的护理服务。一个以病人为中心的医疗之家（PCMH）模式，命名为病人对齐的护理团队（PACT），实施转变VHA初级保健提供过程。VHA使用协作学习模式作为传播PACT概念和变化的关键方法。描述和检查VHA使用突破系列协作方法传播PACT转型的经验。观察性研究。来自141个团队的约250-350人参加了为期21个月的6次面对面学习课程。1）PACT协作参与者调查; 2）教练评估分数和计划-执行-学习-行动（PDSA）数据;和3）PACT指南（评估退伍军人事务部医疗保健系统内PACT实施情况的国家措施）。在合作期间，PDSA的数量稳步增加; 93%（n = 1，547）的PDSA成功实施。团队成功实现了80%以上的目标，这与PDSA的实施高度相关（R-2 = 0.88）。实现的最成功的目标是提供当天预约，增加非面对面的护理，并改善团队沟通。PACT指南针显示协作后有所改善（p值< .000），提供者观察到他们的护理实践存在差异（p值< 0.002）。这种积极的影响可能是由于PACT模型通过PACT协作的传播，以及其他学习倡议。对于复杂的协作模型，如PACT，可能需要三个以上的学习课程。随着VHA继续通过初级保健传播PACT模型，进入专业/外科护理及其他领域，协作学习模型可能仍然是利用少数教师，教练和工业工程师的有效方式。
Veterans Health Administration (VHA) seeks to improve the delivery of patient-centered care. A Patient-Centered Medical Home (PCMH) Model, named Patient Aligned Care Team (PACT), was implemented to transform the VHA primary care delivery process. VHA used a collaborative learning model as a key approach to disseminate PACT concepts and changes.To describe and examine VHA's experience disseminating PACT transformation using a Breakthrough Series Collaborative method.Observational study.Approximately 250-350 individuals from 141 teams participated in six face-to-face learning sessions across 21 months.1) PACT Collaborative participant surveys; 2) Coach Assessment Scores and Plan-Do-Study-Act (PDSA) data; and 3) PACT Compass (national measures to assess PACT implementation within VA healthcare system).A majority of the participants indicated that the PACT Collaborative was necessary to implement PACT. The number of PDSAs increased steadily during the Collaborative period; 93 % (n = 1,547) of PDSAs were successfully implemented. Teams successfully achieved over 80 % of their aims, which were highly correlated with PDSAs implemented (R-2 = 0.88). The most successful aims achieved were offering same-day appointments, increasing non-face-to-face care, and improving team communication. PACT Compass indicated an improvement after the Collaborative (p-value < .000), and providers observed differences in their care practice (p-value < 0.002). This positive impact may be due to the spread of the PACT Model through the PACT Collaborative, among other learning initiatives.For complex collaborative models such as PACT, more than three learning sessions may be required. As VHA continues to disseminate the PACT Model through primary care, into specialty/surgical care and beyond, the Collaborative Learning Model may continue to be an effective way to leverage a small number of faculty, coaches, and industrial engineers across an extremely large population.