Transformation to Patient-Centered Medical Home in CareOregon Clinics

描述（由申请人提供）：历史上服务不足的人群，如医疗补助受益人往往有严重的问题，获得全面的，文化能力，协调的初级保健，特别是积极的慢性病护理。按服务收费的支付制度实际上没有为这些服务提供额外的补偿，这对过度劳累的初级保健医生提供这些服务的激励产生了负面影响。因此，与得到较好服务的人口相比，这些人口的结果较差，费用较高。为了解决这些问题，以病人为中心的医疗之家（PCMH）已被提出作为一种新的初级保健模式。PCMH代表了一个整体实践的重新设计，强调访问，连续性，全面性和协调的价值，促进慢性病护理模式，使用先进的信息技术，并重新调整报销模式，以改善访问和结果。PCMH模型已经满足了极大的热情，然而，在大多数场馆的有效数据的PCMH的能力，以改善结果，同时控制成本是相当稀疏。2007年，波特兰的一个非营利医疗补助管理式护理计划-俄勒冈州护理公司与选定的初级保健实践机构合作，让其成员实施初级保健更新（PCR）项目。PCR提供报销和其他支持，以鼓励提供多学科、协调和全面护理的做法。参与实践同意实施基于团队和客户驱动的护理，无障碍通道，主动面板健康改善，现场或以其他方式集成的行为健康。内部绩效评估导致CareOregon相信PCR在某些质量指标上取得了早期成功。推而广之，我们相信PCR的经验是有用的识别，描述，并最终传播的技术，转化初级保健的高度有益的方式，病人，供应商和卫生保健系统一般。 我们的目标是：1）定量验证PCR转型后参与实践的医疗质量改进; 2）定性识别和描述促成1）成功的背景和组织因素; 3）执行基础广泛的传播计划，以达到对医疗之家实施可能感兴趣的组织的最广泛受众。 公共卫生相关性：以患者为中心的医疗之家（PCMH）已被提议作为初级保健的模式。PCMH转型项目评估安全网初级保健实践的哪些要素有助于成功转型为以患者为中心的护理。我们将研究这些转变如何影响医疗质量和整体医疗保健成本的医疗补助人口服务的这些诊所。我们的研究结果将是有价值的初级保健诊所和医疗补助健康计划，旨在提高初级保健的质量，同时避免不必要的住院和急诊室访问。

DESCRIPTION (provided by applicant): Historically underserved populations such as Medicaid beneficiaries often have serious problems accessing comprehensive, culturally competent, and coordinated primary care, especially proactive chronic care. Fee-for-service payment systems provide virtually no added reimbursement for such services, negatively affecting incentives of overworked primary care physicians, to provide them. Thus, these populations experience poorer outcomes and higher costs than those experienced by better served populations. To address these problems, the patient-centered medical home (PCMH) has been proposed as a new primary care model. The PCMH represents a whole-practice redesign emphasizing values of access, continuity, comprehensiveness, and coordination, promoting the chronic care model, using sophisticated information technology, and realigning reimbursement models to improve access and outcomes. The PCMH model has met with great enthusiasm; however, in most venues valid data on the PCMH's ability to improve outcomes while controlling costs are quite sparse. In 2007, CareOregon, a nonprofit Medicaid managed care plan in Portland, worked with selected primary care practices that see its members to implement the Primary Care Renewal (PCR) project. PCR provides reimbursement and other support to encourage practices to provide multidisciplinary, coordinated, comprehensive care. Participating practices agree to implement team-based and customer-driven care, barrier-free access, proactive panel health improvement, and onsite or otherwise integrated behavioral health. Internal performance assessments lead CareOregon to believe that PCR is having early success on certain quality metrics. By extension, we believe that the PCR experience is useful for identifying, describing, and ultimately disseminating techniques of transforming primary care in highly beneficial ways to patients, providers, and health care systems generally. Our objectives are to 1) validate quantitatively healthcare quality improvements at participating practices after PCR transformation; 2) identify and describe qualitatively contextual and organizational factors that contributed to the successes in 1); and 3) execute a broad-based dissemination plan to reach the widest possible audience of organizations potentially interested in medical home implementation. PUBLIC HEALTH RELEVANCE: The patient-centered medical home (PCMH) has been proposed as a model for primary care. The PCMH Transformation project evaluates which elements of safety-net primary care practices contribute to successful transformation to patient-centered care. We will examine how such transformations affected quality of care and overall health-care costs for Medicaid populations served by these clinics. Our findings will be valuable to primary care clinics and Medicaid health plans aiming to improve quality of primary care while avoiding unnecessary hospitalizations and emergency department visits.