Context for understanding the National Demonstration Project and the patient-centered medical home.
Context for understanding the National Demonstration Project and the patient-centered medical home.
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DOI：
10.1370/afm.1110
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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：
Stange, Kurt C;Miller, William L;Jaen, Carlos Roberto
本文介绍了一个杂志增刊评估该国的第一个国家示范的病人为中心的医疗之家（PCMH）的概念。PCMH被一些人吹捧为重振美国医疗保健系统及其初级保健基础的关键。国家示范项目（NDP）测试了一种新的护理模式，并在一项分组随机临床试验中比较了便利和自我指导的实施方法。NDP询问了在当前美国医疗保健支付和组织系统内，在2年内，36个高度积极的家庭实践的全国样本可以实现PCMH理想。我们的独立评估使用了多方法方法，该方法集成了定性方法，从多个角度讲述NDP故事，并使用定量方法评估和比较可以衡量的方面。本补编中的7份科学报告解释了NDP的过程、结果、教训和影响。这篇介绍性文章提供了理解NDP的背景。重要的背景包括PCMH概念和运动的演变，NDP的根源及其发展，以及家庭医学和初级保健的价值和问题。总之，本增刊中的文章显示了初级保健实践和PCMH的概念如何继续发展。该评估描述了这种演变对患者和实践的一些早期影响，并显示了如何理解实践发展的过程，以及如何从NDP的经验教训可以告知正在进行和未来的努力，以改变初级保健和医疗保健系统。
This article introduces a journal supplement evaluating the country's first national demonstration of the patient-centered medical home (PCMH) concept. The PCMH is touted by some as a linchpin for renewing the foundering US health care system and its primary care foundation. The National Demonstration Project (NDP) tested a new model of care and compared facilitated and self-directed implementation approaches in a group-randomized clinical trial. The NDP asked what a national sample of 36 highly motivated family practices could accomplish in moving toward the PCMH ideal during 2 years within the current US health care payment and organizational system. Our independent evaluation used a multimethod approach that integrated qualitative methods to tell the NDP story from multiple perspectives and quantitative methods to assess and compare aspects that could be measured. The 7 scientific reports presented in this supplement explain the process, outcomes, lessons, and implications of the NDP. This introductory article provides context for making sense of the NDP. Important context includes the evolution of the PCMH concept and movement, the roots of the NDP and how it developed, and both what is valuable and what is problematic about family medicine and primary care. Together, the articles in this supplement show how primary care practices and the concept of the PCMH can continue to evolve. The evaluation depicts some of the early effects of this evolution on patients and practices, and shows how the process of practice development can be understood and how lessons from the NDP can inform ongoing and future efforts to transform primary care and health care systems.