Patient outcomes at 26 months in the patient-centered medical home National Demonstration Project.
Patient outcomes at 26 months in the patient-centered medical home National Demonstration Project.
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DOI：
10.1370/afm.1121
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发表时间：
2010-01-01
影响因子：
4.4
通讯作者：
Stange, Kurt C
中科院分区：
文献类型：
--
作者：
Jaen, Carlos Roberto;Ferrer, Robert L;Stange, Kurt C
目的：本研究的目的是评估国家医疗机构向以患者为中心的医疗机构过渡的示范项目(NDP)的患者效果。方法：2006年，共有36个家庭机构被随机分为促进型和自主型干预组。通过对这些做法采用的39个主要是技术上的NDP模式组成部分中的多少个进行独立评估，来衡量朝着PCMH取得的进展。我们在基线、9个月和26个月通过重复的横断面调查和医疗记录审计评估了两种类型的患者结果：患者分级结果和特定条件的护理质量结果。患者评估的结果包括核心初级保健属性、患者赋权、一般健康状况和对服务关系的满意度。具体情况的结果是来自动态护理质量联盟(ACQA)启动集的护理质量的测量以及临床预防服务和慢性病护理的交付测量。结果：在26个月的时间里，实践采用了大量的NDP组件。促进实践比自我指导实践平均采用了更多的新组件(10.7个组件比7.7个组件，P=0.005)。随着时间的推移，两组患者的ACQA评分均有改善(促进组提高了8.3%，自我指导组提高了9.1%，P
PURPOSE: The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices' transition to patient-centered medical homes (PCMHs).METHODS: In 2006, a total of 36 family practices were randomized to facilitated or self-directed intervention groups. Progress toward the PCMH was measured by independent assessments of how many of 39 predominantly technological NDP model components the practices adopted. We evaluated 2 types of patient outcomes with repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months: patient-rated outcomes and condition-specific quality of care outcomes. Patient-rated outcomes included core primary care attributes, patient empowerment, general health status, and satisfaction with the service relationship. Condition-specific outcomes were measures of the quality of care from the Ambulatory Care Quality Alliance (ACQA) Starter Set and measures of delivery of clinical preventive services and chronic disease care.RESULTS: Practices adopted substantial numbers of NDP components over 26 months. Facilitated practices adopted more new components on average than self-directed practices (10.7 components vs 7.7 components, P=.005). ACQA scores improved over time in both groups (by 8.3% in the facilitated group and by 9.1% in the self-directed group, P