The post-Katrina conversion of clinics in New Orleans to medical homes shows change is possible, but hard to sustain.
The post-Katrina conversion of clinics in New Orleans to medical homes shows change is possible, but hard to sustain.
复制标题
卡特里娜飓风过后，新奥尔良的诊所改建为医疗之家，这表明变革是可能的，但难以维持。
作者：
D. Rittenhouse;L. Schmidt;Kevin J. Wu;J. Wiley
Hurricane Katrina destroyed much of the health care infrastructure in and around New Orleans in 2005. We describe a natural experiment that occurred afterward, amid efforts to rebuild the city's health care system, in which diverse safety-net clinics were transformed into medical homes. Using surveys of clinic leaders and administrative data, we found that clinics made substantial progress in implementing new clinical processes to improve access, quality and safety, and care coordination and integration. But there was wide variation, with some clinics making only minimal progress. Because the transformation was closely tied to the receipt of federal grants and bonus payments, we observed declines in performance toward the end of the study, when clinics faced diminished federal funding and refocused their priorities on survival. Now that federal funds have dried up, moreover, clinics may be losing ground in sustaining their practice changes. The experience shows that payment to support medical home transformation must be robust and stable, and clinics need to be fully integrated into the broader health care system to improve overall coordination of care.
