Improved Outcomes Associated With Medical Home Implementation in Pediatric Primary Care
Improved Outcomes Associated With Medical Home Implementation in Pediatric Primary Care
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DOI：
10.1542/peds.2008-2600
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发表时间：
2009-07-01
期刊：
影响因子：
8
通讯作者：
Kuhlthau, Karen
中科院分区：
文献类型：
--
作者：
Cooley, W. Carl;McAllister, Jeanne W.;Kuhlthau, Karen
目的：医疗之家模式强调有计划的护理、护理协调、以家庭为中心的方法和质量，为初级保健的重新设计提供了一个有吸引力的概念结构。对医疗之家组成部分的研究表明，医疗之家的质量有所提高，成本有所降低，但医疗之家的整体模式尚未得到系统的研究。本研究检验了这一假设，即增加医疗家庭在初级保健的做法是与卫生服务的利用率下降，增加病人satisfactions.METHODS：43初级保健的做法，确定通过7个健康计划在5个州。使用医疗家庭指数（MHI），每个实践的医疗家庭的概念“医疗家庭”的实施进行了测量。保健计划提供了前一年患有6种慢性病的儿童的利用数据。该计划确定了42名儿童在每一个实践与这些慢性病和调查他们的家庭满意度与护理和负担的illumination.RESULTS：较高的MHI分数和较高的子域分数的组织能力，护理协调，慢性病管理与显着减少住院。较高的慢性病管理评分与较低的急诊使用率相关。家庭调查数据没有产生可识别的趋势，就医疗家庭measurement.CONCLUSIONS：发展的基础证据的初级保健医疗家庭的价值提供者，付款人，政策制定者和消费者的重要性。通过加强初级保健减少住院为支持家庭医疗服务（如护理协调）的新报销战略提供了一个潜在的案例。需要进行更大规模的研究，以进一步发展/审查这些关系。儿科2009; 124：358-364
OBJECTIVE: The medical home model with its emphasis on planned care, care coordination, family-centered approaches, and quality provides an attractive concept construct for primary care redesign. Studies of medical home components have shown increased quality and reduced costs, but the medical home model as a whole has not been studied systematically. This study tested the hypothesis that increased medical homeness in primary care practice is associated with decreased utilization of health services and increased patient satisfaction.METHODS: Forty-three primary care practices were identified through 7 health plans in 5 states. Using the Medical Home Index (MHI), each practice's implementation of medical home concepts "medical homeness" was measured. Health plans provided the previous year's utilization data for children with 6 chronic conditions. The plans identified 42 children in each practice with these chronic conditions and surveyed their families regarding satisfaction with care and burden of illness.RESULTS: Higher MHI scores and higher subdomain scores for organizational capacity, care coordination, and chronic-condition management were associated with significantly fewer hospitalizations. Higher chronic-condition management scores were associated with lower emergency department use. Family survey data yielded no recognizable trends with respect to the medical home measurement.CONCLUSIONS: Developing an evidence base for the value of the primary care medical home has importance for providers, payers, policy makers, and consumers. Reducing hospitalizations through enhanced primary care provides a potential case for new reimbursement strategies supporting medical home services such as care coordination. Larger-scale studies are needed to further develop/examine these relationships. Pediatrics 2009; 124: 358-364