Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home
Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home
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DOI：
10.1370/afm.1002
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发表时间：
2009-05-01
影响因子：
4.4
通讯作者：
Stange, Kurt C.
中科院分区：
文献类型：
--
作者：
Nutting, Paul A.;Miller, William L.;Stange, Kurt C.
以病人为中心的医疗之家（PCMH）正在成为多种医疗保健改革努力的潜在催化剂。几乎每个州都开始实施示范项目，并得到雇主、保险公司、州和联邦机构以及专业组织的广泛支持。沿着国家质量保证委员会的三级认可程序，一种显示PCMH可行性的紧迫感正在影响许多示范的设计和实施。2006年6月，美国家庭医生学会启动了第一个国家示范项目（NDP），在36个家庭实践的不同国家样本中测试PCMH模型。作者组成了一个独立的评估小组，使用多方法评估策略，包括直接观察，深入访谈，图表审计，患者和实践调查。NDP实时定性分析的早期经验教训对许多拟议的PCMH示范项目的当前方向提出了一些严重关切，并指出了一些积极的机会。我们描述了NDP的6个早期经验教训，解决了这些问题，然后为那些帮助初级保健实践转型的人提供了4条建议，并为尝试转型的个人实践提供了4条建议。Ann Fam Med 2009;7：254-260. DOI：10.1370/afm.1002。
The patient-centered medical home (PCMH) is emerging as a potential catalyst for multiple health care reform efforts. Demonstration projects are beginning in nearly every state, with a broad base of support from employers, insurers, state and federal agencies, and professional organizations. A sense of urgency to show the feasibility of the PCMH, along with a 3-tiered recognition process of the National Committee on Quality Assurance, are influencing the design and implementation of many demonstrations. In June 2006, the American Academy of Family Physicians launched the first National Demonstration Project (NDP) to test a model of the PCMH in a diverse national sample of 36 family practices, The authors make up an independent evaluation team for the NDP that used a multimethod evaluation strategy, including direct observation, in-depth interviews, chart audit, and patient and practice surveys. Early lessons from the real-time qualitative analysis of the NDP raise some serious concerns about the cur rent direction of many of the proposed PCMH demonstration projects and point to some positive opportunities. We describe 6 early lessons from the NDP that address these concerns and then offer 4 recommendations for those assisting the transformation of primary care practices and 4 recommendations for individual practices attempting transformation. Ann Fam Med 2009;7:254-260. DOI: 10.1370/afm.1002.