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、有文化能力和协调的初级保健方面存在严重问题，特别是积极主动的慢性保健。按服务收费的支付系统几乎没有为这种服务提供额外的补偿，这对过度工作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，这些人群经历了更差的结果和更高的成本。为了解决这些问题，以患者为中心的医疗之家(PCMH)被提出为一种新的初级保健模式。PCMH代表了一种全面的重新设计，强调获取、连续性、全面性和协调性的价值，促进慢性护理模式，使用复杂的信息技术，并重新调整补偿模式，以改善获取和成果。PCMH模式受到了极大的欢迎；然而，在大多数情况下，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保健计划CareOregon与与其成员见面的选定初级保健实践机构合作，实施初级保健更新(PCR)项目。合作伙伴关系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、主动式小组健康改善以及现场或以其他方式整合的行为健康。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。推而广之，我们认为，PCR经验有助于识别、描述并最终传播以高度有益的方式转变初级保健的技术，使患者、提供者和卫生保健系统普遍受益。我们的目标是1)在参与的实践中验证在PCR改造后的医疗质量改进；2)确定并定性描述促成1)成功的背景和组织因素；以及3)执行基础广泛的传播计划，以接触到可能对医疗之家实施感兴趣的最广泛的受众。 公共卫生相关性：以患者为中心的医疗院(PCMH)已被提议作为初级保健的模式。PCMH转型项目评估了安全网初级保健实践的哪些要素有助于成功地向以患者为中心的保健转型。我们将研究这些转变如何影响这些诊所所服务的医疗补助人群的护理质量和总体医疗保健成本。我们的发现将对初级保健诊所和医疗补助健康计划具有价值，旨在提高初级保健的质量，同时避免不必要的住院和急诊科就诊。

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.