Outcomes, Incentives, and Improvements in Collaboratives

描述(由申请人提供)：1998年，初级卫生保健局(BPHC)，卫生资源和服务管理局的一部分，监督所有联邦资助的卫生中心，开始了一项为期6年的重大健康差距合作努力，旨在减少卫生差异和提高卫生中心的护理质量。该计划旨在通过医疗保健改进研究所的突破系列方法、MacColl医疗保健创新研究所的慢性护理模式以及区域或国家学习会议来快速提高质量。芝加哥大学之前的研究表明，在Collaborative的第一年，医疗保健得到了改善，但卫生中心发现了进一步提高质量的几个挑战。 因此，调查人员有三个具体目标： 1)确定健康差距协作组(HDC)在倡议的六年期间是否改善了患者的护理质量和结果。 2)确定如何提高卫生发展中心的有效性、可持续性和传播性，特别强调寻求了解和改善对卫生中心领导人和其他工作人员的激励和援助。 3)评估HDC的成本和成本效益，以评估从卫生中心和社会角度来看，有效、可持续和能够推广的护理质量改善是否在财务上可行。 调查人员计划对美国中西部和中西部地区的大约200家医疗中心进行研究。在已经参与糖尿病合作评估的32个健康中心的子集上，将获得进一步的图表审查和患者调查的绩效指标。在200个卫生中心中，领导人和工作人员将接受书面调查，重点是确定哪些激励措施和援助将是有帮助的，并将对一个子样本进行半结构化访谈。研究人员将进行一般成本描述，并使用正式的、经过充分验证的模型对Collaborative进行糖尿病成本效益分析。该项目将有助于为未来改善卫生中心慢性护理管理的努力提供信息。

DESCRIPTION (provided by applicant): In 1998 the Bureau of Primary Health Care (BPHC), the part of the Health Resources and Services Administration that oversees all federally-funded health centers, began a major 6-year Health Disparities Collaborative effort designed to reduce health disparities and improve the quality of care in health centers. The initiative aims for rapid quality improvement through the Institute for Healthcare Improvement's Breakthrough Series methodology, the MacColl Institute for Healthcare Innovation's Chronic Care Model, and regional or national learning sessions. Previous work by the University of Chicago indicated that care improved in the first year of the Collaborative, but that health centers had identified several challenges to further quality improvement. Therefore, the investigators have three specific aims: 1) To determine if the Health Disparities Collaboratives (HDC) have improved the quality of care and outcomes of patients over the six-year span of the initiative. 2) To determine ways to enhance the effectiveness, sustainability, and spread of the HDC, with a special emphasis on seeking to understand and improve incentives and assistance for both leaders and other staff at the health centers. 3) To evaluate the costs and cost-effectiveness of the HDC, in order to assess whether quality of care improvements that are effective, sustainable, and capable of spread are also viable financially from health center and societal perspectives. Investigators plan to study approximately 200 health centers in the Midwest and West Central regions of the country. On a subset of 32 health centers already involved in a Diabetes Collaborative evaluation, further chart review and patient surveys for performance indicators will be obtained. On the universe of 200 health centers, leaders and staff will be given written surveys with an emphasis on determining incentives and assistance that would be helpful, and semi-structured interviews will be performed on a subsample. Investigators will perform general cost descriptions, and use formal, well-validated models for diabetes cost-effectiveness analyses of the Collaborative. This project will help inform future efforts to improve chronic care management in health centers.