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，通常在获得全面的、文化上有能力的和协调的初级保健方面存在严重问题，特别是主动的慢性保健。按服务收费的支付系统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动机产生了负面影响。因此，与服务较好的人群相比，这些人群的结果更差，成本更高。为了解决这些问题，以患者为中心的医疗之家（PCMH）被提出作为一种新的初级保健模式。PCMH代表了整体实践的重新设计，强调可及性、连续性、全面性和协调性的价值，推广慢性护理模式，使用复杂的信息技术，并重新调整报销模式以改善可及性和结果。PCMH模式受到了极大的欢迎；然而，在大多数地方，关于PCMH在控制成本的同时改善结果的能力的有效数据相当稀少。2007年，波特兰的非营利性医疗补助管理计划CareOregon与选定的初级保健机构合作，让其成员实施初级保健更新（PCR）项目。聚合酶链反应提供报销和其他支持，以鼓励提供多学科、协调、全面的护理。参与实践同意实施基于团队和客户驱动的护理、无障碍访问、积极的小组健康改善以及现场或其他综合行为健康。内部绩效评估使CareOregon相信PCR在某些质量指标上取得了初步成功。进一步说，我们相信PCR的经验对于识别、描述和最终传播以对患者、提供者和卫生保健系统非常有益的方式转变初级保健的技术是有用的。我们的目标是1)定量验证PCR转化后参与实践的医疗质量改进；2)定性地识别和描述促成1)成功的环境和组织因素；3)执行一个基础广泛的传播计划，以达到对医疗家庭实施感兴趣的组织的尽可能广泛的受众。

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.