Policy Challenges in Building the Medical Home: Do We Have a Shared Blueprint?
Policy Challenges in Building the Medical Home: Do We Have a Shared Blueprint?
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DOI：
10.3122/jabfm.2010.03.090140
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发表时间：
2010-05-01
影响因子：
2.9
通讯作者：
DeVoe, Jennifer E.
中科院分区：
文献类型：
--
作者：
Stenger, Robert J.;DeVoe, Jennifer E.
背景：以患者为中心的医疗之家的概念在全国各地的政策改革举措中占有突出地位，州和联邦立法都关注这一新模式。我们试图了解主要利益相关者的观点，并研究政策制定者和从业者在试图将医疗之家概念转化为广泛的实践变革时面临的挑战。方法：我们回顾了2007年各州立法会议的立法文件，以确定包含医疗之家概念的立法。同时，在2007年医疗改革立法通过后，我们对俄勒冈州主要利益相关者进行了有目的的半结构化访谈样本，对去识别的实地记录进行了深入的定性分析。结果：2007年，全国各州立法进一步界定和阐述了医疗之家的概念，一些联邦和州的示范项目已经在进行中。然而，我们发现了一些阻碍医疗之家广泛实施的障碍，最明显的是缺乏明确的操作定义。主要利益相关者对医疗家庭示范成功的核心要素有广泛不同的看法，包括交付系统改革、支付改革和对提供者的绩效激励。结论：自2007年以来，医疗之家的概念在医疗改革辩论中获得了越来越多的关注。我们的研究结果表明，要将这一概念转化为成功的、广泛的改革，政策制定者需要在关键利益相关者之间建立进一步的共识，并要求他们解决关键障碍，以避免重复过去改革努力的陷阱。[J] .中国医学杂志2010；23:384-392。]
Background: The notion of a patient-centered medical home features prominently in policy reform initiatives across the country, with both state and federal legislation focusing on this new model. We sought to understand the views of key stakeholders and to examine the challenging landscape facing policymakers and practitioners as they attempt to translate the medical home concept into widespread practice change.Methods: We reviewed legislative documents from state legislative sessions in the year 2007 to identify pieces of legislation that included the medical home concept. Concurrently we conducted an in-depth qualitative analysis of de-identified field notes from a purposeful sample of semistructured interviews conducted with key stakeholders in Oregon after the passage of health reform legislation in 2007.Results: Legislation that further defined and expounded on the medical home concept was introduced in states across the country in 2007, and some federal and state demonstration projects were already underway. However, we identified a number of barriers to widespread implementation of the medical home, most notably lack of a clear operational definition. Key stakeholders had widely disparate views about elements central to the success of medical home demonstrations, including delivery system reform, payment reform, and performance incentives for providers.Conclusions: Since 2007 the concept of the medical home has gained increasing attention in health care reform debates. Our findings suggest that translating this concept into successful, widespread reform will require that policymakers build further consensus among key stakeholders and require them to address critical barriers to avoid repeating pitfalls of past reform efforts. (J Am Board Fam Med 2010;23:384-392.)