Primary Care Practice Redesign - Successful Strategies

初级保健实践重新设计 - 成功策略

• 批准号: 8060185
• 负责人: MICHAEL K MAGILL
• 金额: $ 298.41万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8060185
• 关键词: Primary; Care; Practice; Redesign; Successful

DESCRIPTION (provided by applicant): Summary The purpose of this project is to demonstrate major improvements in care quality through redesign of care delivery in the University of Utah Community Clinics. The Community Clinics (CC) are a fee-for-service 10-site primary- and secondary-care system with about 50 primary care physicians, 350,000 annual visits, and 120,000 active patients. The CC have led primary care delivery reform since 2003 when we began the development and implementation of a new model of care called Care By Design (CBD). The three organizing principles of CBD are: Appropriate Access (AA), Care teams (CT), and Planned care (PC). It is within this existing system design that we will implement additional redesigns. In this project we will implement a comprehensive care management program targeted to patients with multiple chronic conditions. Our delivery redesign will include strategies for effectively managing care transitions and for aggressively screening for and treating depression, a complicating co-morbidity for many patients with chronic conditions. Our intervention builds upon and strengthens CBD in order to achieve major improvements in care quality. We will compare the CCs' current clinical outcomes with outcomes prior to introduction of CBD's system designs and with those achieved with our redesign components. In addition, a quasi- experimental cohort design will document improvements in clinical quality and engagement of patients and care teams as clinics enhance CBD sequentially over the three year project. Intermediate outcomes will include provider and staff use rates of EMR best practice reminders and patient and care team adherence to CER-informed guidelines. Patient engagement will be assessed by patient use of our web portal, care manager supports, and adherence to personalized care plans. We will use our EMR and CBD implementation instrument to assess staff, provider, and patient behavior, and surveys of patient activation, experience with care, and quality of life, and of provider attitudes toward patient self-management to assess quality. An important goal of our project is evaluation of the impact of our interventions and strategies on clinic ROI. We anticipate changes in volume and related revenue for ancillary tests, services, and pharmacy as we manage the care needs of our high risk patients more effectively. We will evaluate the business case for implementing currently uncompensated components of care in our fee for service environment. Additionally, by using two unique state-wide databases, we will evaluate the impact of our redesign on total cost and cost effectiveness of care by measuring emergency department visits, hospital admissions, readmissions, and associated costs of care, demonstrating the potential for decreased costs of care in the broader community. These data are key to creating a business model for sustainability of enhanced CER-informed care. Our strong interdisciplinary research team ensures successful completion of this project. The team includes developers of CBD, clinician specialists in geriatrics and pharmacy practice, members with expertise in quality improvement, biostatistics, qualitative research, behavioral sciences, and economics, and a national advisory committee that includes leading experts in practice redesign and multi-methods evaluation. Results of this project will provide practical guidance for others seeking to implement CER-informed care in primary care practices. PUBLIC HEALTH RELEVANCE: This project specifically addresses the purposes of the grant program to demonstrate the feasibility and value of implementing evidence-based care improvement strategies and interventions in delivery systems as well as a number of objectives of Healthy People 2010 including improving access to comprehensive, high-quality health care services. This project implements a comprehensive program of care management for patients with multiple chronic conditions and evaluates the impact of transformation to a PCMH delivery model of primary care practices in a University network serving a broad patient population. The project addresses a broad goal for Healthy People 2010, to "Achieve access to preventive services for all Americans" by implementing best practices reminders in our EMR, pre-visit planning, and registry-based outreach.

描述（由申请人提供）：摘要本项目的目的是通过重新设计犹他州大学社区诊所的护理服务，证明护理质量的重大改善。社区诊所（CC）是一个收费服务的10个站点的初级和二级保健系统，约有50名初级保健医生，每年有350，000人次就诊，120，000名活跃患者。自2003年以来，CC一直领导初级保健服务改革，当时我们开始制定和实施一种名为“设计护理”的新护理模式。CBD的三个组织原则是：适当获取（AA），护理团队（CT）和计划护理（PC）。我们将在现有系统设计的范围内实施额外的重新设计。在这个项目中，我们将实施针对多种慢性病患者的综合护理管理计划。我们的交付重新设计将包括有效管理护理过渡的策略，以及积极筛查和治疗抑郁症的策略，抑郁症是许多慢性病患者的并发症。我们的干预措施建立在CBD的基础上并加强CBD，以实现护理质量的重大改善。我们将比较CC当前的临床结果与引入CBD系统设计之前的结果以及使用我们的重新设计组件实现的结果。此外，准实验性队列设计将记录临床质量的改善以及患者和护理团队的参与，因为诊所在三年的项目中依次增强CBD。中间结果将包括提供者和工作人员对EMR最佳实践提醒的使用率以及患者和护理团队对CER知情指南的遵守情况。患者参与度将通过患者使用我们的门户网站、护理经理支持和遵守个性化护理计划来评估。我们将使用我们的EMR和CBD实施工具来评估工作人员，提供者和患者的行为，并调查患者的激活，护理经验和生活质量，以及提供者对患者自我管理的态度，以评估质量。我们项目的一个重要目标是评估我们的干预措施和策略对临床ROI的影响。我们预计，随着我们更有效地管理高风险患者的护理需求，辅助检测、服务和药房的数量和相关收入将发生变化。我们将评估在我们的收费服务环境中实施目前未补偿的护理组成部分的商业案例。此外，通过使用两个独特的全州数据库，我们将评估我们的重新设计对总成本和成本效益的影响，通过衡量急诊科就诊，住院，再入院和相关的护理成本，证明在更广泛的社区降低护理成本的潜力。这些数据是创建增强CER知情护理可持续性的商业模式的关键。我们强大的跨学科研究团队确保了该项目的成功完成。该团队包括CBD的开发人员，老年医学和药学实践的临床专家，具有质量改进，生物统计学，定性研究，行为科学和经济学专业知识的成员，以及包括实践重新设计和多方法评估方面的领先专家的国家咨询委员会。该项目的结果将为寻求在初级保健实践中实施CER知情护理的其他人提供实用指导。 公共卫生关系：该项目具体涉及赠款方案的目的，以证明实施循证护理改进战略和干预措施的可行性和价值，以及2010年健康人的一些目标，包括改善获得全面，高质量的医疗保健服务。该项目为患有多种慢性疾病的患者实施了一项全面的护理管理计划，并评估了在为广泛患者群体服务的大学网络中，向初级保健实践的PCMH交付模式转变的影响。该项目致力于实现2010年健康人的广泛目标，即通过在我们的EMR、访前规划和基于登记的外展中实施最佳做法提醒，“为所有美国人提供预防服务”。