Recognition as a Patient-Centered Medical Home: Fundamental or Incidental?
Recognition as a Patient-Centered Medical Home: Fundamental or Incidental?
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DOI：
10.1370/afm.1488
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发表时间：
2013-05-01
影响因子：
4.4
通讯作者：
Tai-Seale, Ming
中科院分区：
文献类型：
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作者：
Dohan, Daniel;McCuistion, Mary Honodel;Tai-Seale, Ming
医疗团体寻求以患者为中心的医疗之家（PCMH）的原因知之甚少。我们研究了在一组寻求认可的动机，并评估了为什么该集团允许承认失效3 years later.METHODS作为一个更大的混合方法的案例研究的一部分，我们进行了38个关键的线人采访与高管，临床医生和一线工作人员。访谈是根据项目期间制定的指南进行的，并进行了录音和完全转录。结果PCMH的原则与组织的文化和使命一致，即重视创新和把病人放在第一位。实施具体的PCMH组件的动机各不相同;一些组件被视为该组织以患者为中心的文化的一部分，而其他组件则有助于实践在当地市场的竞争。举报人一致报告说，国家质量保证委员会的认可偶然出现，因为1次激励从当地一组大雇主，因为该组织决定分配一些组织资源，以应对复杂的报告要求约一半的clinics.CONCLUSIONS成为以病人为中心，并寻求承认，因为这样跑沿着单独的，但在这个组织内的平行轨道。随着《平价医疗法案》继续将注意力集中在初级保健的重新设计上，这种明显的脱节应该被铭记在心。
PURPOSE Little is known about reasons why a medical group would seek recognition as a patient-centered medical home (PCMH). We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later.METHODS As part of a larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, and front-line staff. Interviews were conducted according to a guide that evolved during the project and were audio-recorded and fully transcribed. Transcripts were analyzed and thematically coded.RESULTS PCMH principles were consistent with the organization's culture and mission, which valued innovation and putting patients first. Motivations for implementing specific PCMH components varied; some components were seen as part of the organization's patient-centered culture, whereas others helped the practice compete in its local market. Informants consistently reported that National Committee for Quality Assurance recognition arose incidentally because of a 1-time incentive from a local group of large employers and because the organization decided to allocate some organizational resources to respond to the complex reporting requirements for about one-half of its clinics.CONCLUSIONS Becoming patient centered and seeking recognition as such ran along separate but parallel tracks within this organization. As the Affordable Care Act continues to focus attention on primary care redesign, this apparent disconnect should be borne in mind.