Understanding the Transformation Experiences of Small Practices with NCQA's Med

描述(由申请人提供)：以患者为中心的医疗之家(PCMH)的概念正受到越来越多的关注，作为一种改善护理的潜在手段。支付者、购买者和政策制定者将其视为降低成本和提高质量的工具，部分是通过振兴初级保健。了解小诊所的实践转变可以帮助我们加快采用PCMH，因为在这个国家，绝大多数初级保健是通过小诊所提供的，但迄今为止大多数关于质量改进的研究都集中在大型医疗集团。我们建议通过NCQA的医生实践连接(R)--以患者为中心的医疗之家(PPC(R)-PCMH)计划获得认可，从而利用已经证明PCMH模式实施的全国实践清单。这些标准是从研究、咨询小组、试点测试和公众意见中开发出来的，并得到了国家质量论坛、众多医生组织和利益相关者的认可，作为PCMH示范项目合格实践的标准化工具。在获得认可的实践中，超过一半的医生不到5人。这些小型诊所分布在14个不同的州，在规模、所有权和所服务的患者群体方面各不相同。在我们与领先的质量改进研究人员不断合作的基础上，我们将：1)详细说明已成功实施PCMH模式(基于3级PPC-PCMH认可的实现)并代表不同状态、组织特征、PCMH示范计划和患者群体的小型医生实践之间的转变过程；2)在代表不同州、组织特征、示范计划和患者群体的300个小型实践中，识别组织和背景因素，以区分PCMH实施水平较高(基于3级认可)与实施水平较低(1级或2级)的实践；3)比较实施PCMH水平较高和较低的300个小诊所的医生经验；以及4)比较实施PCMH水平较高和较低的300个小诊所的运营成本和收入。我们将使用有目的的10种做法样本的案例研究，收集有关变革进程的定性和定量信息，并查明变革的主要障碍和支持。然后，我们将对300个具有PPC-PCMH认可的小型实践进行全国性调查，以获得更多关于实践转型的概括性知识。这项研究将史无前例地审视支持小型诊所实施PCMH的因素，并使我们能够确定对成功实施PCMH至关重要的支持类型，以及对实践成本/收入和医生工作经验的影响。随着NCQA与多个利益相关者的紧密联系，我们有一个独特的机会将这些发现传播给全国观众，并利用这些结果为我们的计划提供信息。 公共卫生相关性：支付者、购买者和政策制定者将以患者为中心的医疗之家视为降低成本和提高质量的工具，部分是通过振兴初级保健。这项研究将10个案例研究与对300家实施医疗之家的小型实践的全国调查配对，以探索改造过程。这项研究将对支持小型诊所实施PCMH的因素进行前所未有的审视，它将使我们能够确定对成功实施PCMH至关重要的财务和其他支持类型，以及PCMH实施与执业成本/收入和医生工作经验的关系。

DESCRIPTION (provided by applicant): The concept of a Patient-Centered Medical Home (PCMH) is receiving increased attention as a potential means to improve care. Payers, purchasers, and policy makers see it as a vehicle for moderating costs and improving quality, in part through revitalizing primary care. Understanding practice transformation in small practices can help us accelerate the adoption of the PCMH, since the vast majority of primary care in this country is provided through small practices, yet most of the research to date on quality improvement has focused on large medical groups. We propose to take advantage of a national list of practices that have demonstrated implementation of PCMH model by achieving recognition through NCQA's Physician Practice Connections(R)--Patient-Centered Medical Home" (PPC(R)-PCMH) program. These standards were developed from research, advisory groups, pilot tests and public comment and are endorsed by the National Quality Forum, numerous physician organizations, and stakeholders as a standardized tool for qualifying practices for PCMH demonstration projects. Over half of the practices that have achieved recognition have fewer than 5 physicians. These small practices are located in 14 different states and vary in size, ownership, and patient populations served. Building on our ongoing collaboration with leading researchers on quality improvement, we will: 1) Detail the transformation process among small physician practices that have successfully implemented the PCMH model (based on achievement of Level 3 PPC-PCMH recognition) and that represent diverse states, organizational characteristics, PCMH demonstration programs, and patient populations; 2) Identify organizational and contextual factors that distinguish practices with a higher level of PCMH implementation (based on Level 3 recognition) compared to those with lower levels of implementation (Level 1 or 2) among 300 small practices representing diverse states, organizational characteristics, demonstration programs, and patient populations; 3) Compare physician experiences among 300 small practices with higher versus lower levels of PCMH implementation; and 4) Compare operational costs and revenue among 300 small practices with higher versus lower levels of PCMH implementation. We will use case studies of a purposive sample of 10 practices to gather both qualitative and quantitative information on the process of transformation as well as to identify key barriers and supports for change. We will then conduct a national survey of 300 small practices with PPC-PCMH recognition to gain more generalizable knowledge about practice transformation. This study will provide an unprecedented look at the factors that support PCMH implementation in small practices, and will allow us to identify the types of supports that are critical to successful PCMH implementation as well as the impact on practice costs/revenues and physician work experiences. With NCQA's strong ties to multiple stakeholders, we have a unique opportunity to disseminate these findings to a national audience and to use the results to inform our programs. PUBLIC HEALTH RELEVANCE: Payers, purchasers, and policy makers see the Patient-Centered Medical Home as a vehicle for moderating costs and improving quality, in part through revitalizing primary care. This study pairs 10 case studies with a national survey of 300 small practices that have implemented the medical home to explore the transformation process. This study will provide an unprecedented look at the factors that support PCMH implementation in small practices, and it will allow us to identify the types of financial and other supports that are critical to successful PCMH implementation as well as the relationship of PCMH implementation to practice costs/revenues and physician work experiences.