Transformed Primary Care-Care by Design

描述（由申请人提供）：犹他州社区诊所（CC）的大学是一个网络的10个多学科的大学拥有的初级保健实践与不同的患者群体，设置和组织文化。CC于2003年开始实施我们的PCMH版本，我们称之为设计关怀（CBD）。CBD围绕适当获取，护理团队和计划性护理的原则组织，所有这些都得到了自转型开始以来一直存在的强大电子病历（EMR）的支持。我们建议使用定量和定性相结合的方法来记录我们如何完成转型，并确定其临床和操作结果。对于定量分析，我们将使用我们开发的测量工具来评估诊所实施CBD基本组成部分的程度。我们将分析与糖尿病、冠心病、心力衰竭、哮喘和预防保健相关的大量临床质量指标的趋势数据。我们将分析CBD在每个诊所的实施程度与操作措施之间的相关性，如工作人员和供应商，设施和用品的成本。我们将确定CBD的实施和供应商，工作人员和患者的满意度之间的关系。我们将使用新推出的犹他州所有支付者数据库（APD），对65岁以下的患者和65岁以上的患者使用医疗保险数据，检查患者层面的护理总成本。我们还将使用回顾性定性方法分析变革过程本身。通过从开发和实施CBD的领导和临床团队成员那里获得的口述历史，我们将记录实施过程中使用的管理实践，并通过这些关键信息提供者的眼睛评估变革的经验。我们将通过调查其他供应商和员工的组织文化，团队环境和潜在的员工倦怠，获得更广泛的转型体验。我们将通过焦点小组访谈和CAHPS临床医生和小组调查的管理来探索患者的经验，并辅以项目来评估患者对以患者为中心的体验和他们从转变中感知的价值。 公共卫生相关性：以患者为中心的医疗之家（PCMH）模式有望帮助实现访问，质量和成本效益的三重目标。犹他州社区诊所大学通过实施我们的PCMH版本（称为“设计护理”（CBD）），改变了初级保健的实践。我们将使用多种定量和定性方法来确定转型过程的关键成功因素，并衡量转型的成果。我们的经验为寻求变革的其他做法提供了宝贵的经验教训

DESCRIPTION (provided by applicant): The University of Utah Community Clinics (CC) are a network of 10 multidisciplinary university-owned primary care practices with diverse patient populations, settings, and organizational cultures. The CC began implementing in 2003 our version of PCMH, which we call Care by Design (CBD). CBD is organized around the principles of Appropriate Access, Care Teams, and Planned Care, all supported by a robust electronic medical record (EMR) that has been in place since the start of the transformation. We propose to use a combination of quantitative and qualitative methods to document how we accomplished the transformation, and to identify its clinical and operational outcomes. For the quantitative analyses, we will use a measurement tool we have developed to assess the degree to which clinics implemented the essential components of CBD. We will analyze trend data for a large set of clinical quality measures related to diabetes, coronary heart disease, heart failure, asthma and preventive care. We will analyze correlations between extent of implementation of CBD at each clinic with operational measures such as costs for staff and providers, facilities, and supplies. We will identify relationships between CBD implementation and satisfaction of providers, staff, and patients. We will examine total cost of care at the patient level using the newly-available Utah All Payer Database (APD) for those under age 65 years, and using Medicare data for those over age 65. We will also analyze the change process itself using retrospective qualitative methods. Through oral histories obtained from the leadership and clinical team members who developed and implemented CBD, we will document the management practices used during the implementation and assess the experience of change through the eyes of these key informants. We will gain a broader sense of the experience of transformation by surveying other providers and staff about organizational culture, the team environment, and potential staff burnout. We will explore patients' experiences through focus group interviews and through administration of the CAHPS Clinician & Group Survey supplemented with items to assess the patients' experience of patient- centeredness and value they perceive from the transformation. PUBLIC HEALTH RELEVANCE: The Patient-Centered Medical Home (PCMH) model is expected to help achieve the triple aims of access, quality, and cost effectiveness. The University of Utah Community Clinics have transformed practice of primary care by implementing our version of PCMH, known as "Care by Design" (CBD). We will use multiple quantitative and qualitative methods to identify critical success factors for the transformation process, and to measure outcomes of transformation. Our experience holds valuable lessons for other practices seeking to change