Implementing the patient-centered medical home: observation and description of the national demonstration project.
Implementing the patient-centered medical home: observation and description of the national demonstration project.
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DOI：
10.1370/afm.1111
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发表时间：
2010-01-01
影响因子：
4.4
通讯作者：
Jaen, Carlos Roberto
中科院分区：
文献类型：
--
作者：
Stewart, Elizabeth E;Nutting, Paul A;Jaen, Carlos Roberto
目得：我们提供了一个国家示范项目（NDP）的干预，以改变家庭的做法，以病人为中心的医疗homes.METHODS：一个独立的评估小组使用多种数据源和方法来描述的设计和实施的NDP的整体描述。这些活动包括直接观察执行小组和项目会议、实地访问实践、与实践成员和执行小组成员进行深入访谈、获得实践通信（例如，电话、电子邮件）和公共领域材料（例如，NDP网站）。结果：美国家庭医生学会创建了一个名为TransformMED的新部门，该部门于2006年6月推出了为期24个月的NDP。从337个完成广泛在线申请的家庭医学实践中，选择了36个，并随机分配到一个促进组，接受TransformMED的量身定制的密集援助和服务，或一个自我指导组，接受非常有限的援助。来自金融，实践管理和组织心理学不同背景的三位主持人使用了多种实践变革策略，包括现场访问，电子邮件，指标和学习课程。自我指导的实践主要靠自己，但在项目中途自行组织了一次撤退。该项目的干预模式逐渐演变为符合以患者为中心的医疗之家的新兴国家共识原则。独立的评估小组研究了NDP，并提供持续的反馈，以通知implementationprocess.CONCLUSIONS：NDP说明，复杂的实践改变干预措施必须结合联合收割机的干预模式，实施战略和评估的灵活性，以最大限度地提高正在进行的学习。
PURPOSE: We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes.METHODS: An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site).RESULTS: The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process.CONCLUSIONS: The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning.