Defining and measuring the patient-centered medical home.
Defining and measuring the patient-centered medical home.
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DOI：
10.1007/s11606-010-1291-3
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发表时间：
2010-06
影响因子：
5.7
通讯作者：
Gill, James M.
中科院分区：
文献类型：
--
作者：
Stange, Kurt C.;Nutting, Paul A.;Miller, William L.;Jaen, Carlos R.;Crabtree, Benjamin F.;Flocke, Susan A.;Gill, James M.
以病人为中心的医疗之家（PCMH）是四件事：1）初级保健的基本原则：第一次接触，全面性，整合/协调，以及涉及持续伙伴关系的关系; 2）组织实践的新方法; 3）实践的内部能力的发展，以及4）相关的医疗保健系统和报销的变化。所有这些都侧重于改善全体人民、家庭、社区和人口的健康，并提高医疗保健的价值。基层护理的基本原则的价值已确立。这一价值包括与不基于初级保健的医疗保健系统相比，更高的医疗保健质量，更好的全人和人口健康，更低的成本和减少的不平等。将初级保健的核心原则放在首位评估被假设为提供附加值的实践和系统变化评估实践的核心过程和适应性储备的发展评估与功能更强的医疗保健系统和社区资源的整合评估从基本关系和整个系统方面评估PCMH的更容易测量的工具特征产生意外负面后果的可能性认识到由于初级保健的一个基本好处是其适应不同的人，人口和系统，功能PCMH将在不同的设置看起来不同。PCMH所需的实践、组织和医疗保健系统变革方面仍在以高度相关的方式发展。PCMH将继续发展，因为证据来自全国各地正在进行的数百个演示和实验，以及当地和更大的医疗保健系统的变化。努力将实践转变为以病人为中心的医疗之家，必须认识到，评估和重视初级保健的基本特征，提供个性化，公平的医疗保健和促进个人和人口的健康。本文的在线版本（doi：10.1007/s11606-010-1291-3）包含补充材料，可供授权用户使用。
The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices’ internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare. The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to healthcare systems not based on primary care. Giving primacy to the core tenets of primary care Assessing practice and system changes that are hypothesized to provide added value Assessing development of practices’ core processes and adaptive reserve Assessing integration with more functional healthcare system and community resources Evaluating the potential for unintended negative consequences from valuing the more easily measured instrumental features of the PCMH over the fundamental relationship and whole system aspects Recognizing that since a fundamental benefit of primary care is its adaptability to diverse people, populations and systems, functional PCMHs will look different in different settings. The needed practice organizational and health care system change aspects of the PCMH are still evolving in highly related ways. The PCMH will continue to evolve as evidence comes in from hundreds of demonstrations and experiments ongoing around the country, and as the local and larger healthcare systems change. Efforts to transform practice to patient-centered medical homes must recognize, assess and value the fundamental features of primary care that provide personalized, equitable health care and foster individual and population health. The online version of this article (doi:10.1007/s11606-010-1291-3) contains supplementary material, which is available to authorized users.
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