A Multi-payer Patient Centered Medical Home Initiative in Pennsylvania

描述（由申请人提供）：本申请旨在评估第一个区域推出的独特的全州范围内，基于多方利益相关者的实施以患者为中心的医疗之家（PCHM）对宾夕法尼亚州慢性病护理的实践重新设计。这一干预措施的独特之处在于，PA州长医疗改革办公室（GOHCR）促进了基于多支付者的提供者激励措施。这个应用程序建议研究25个实践，涉及到这个全州范围内的倡议，东南PA （SEPA）的第一个地区。SEPA干预于2008年5月开始，包括一个为期3年的学习合作，提高实践绩效（IPIP）实践教练，并要求每月登记和叙述报告。向该区域主要健康保险公司的提供者支付大量财政奖励以促进实施，并由实践、提供者和政府人权办事处之间的合同予以保证。合作的实践类型多种多样，包括家庭医学、内科医学、住院医师和联邦合格健康中心（FQHC）规模不一的实践。多方法评估将包括对临床结果、服务利用和成本的定量评估，定性方法将用于确定意想不到的兴趣结构，并获得对质量、实施过程和程序以及影响PCMH实施和日常绩效的变量的认识。目标是了解这一干预措施的影响，并确定该举措的障碍和促进因素，以帮助传播这一进程，以改善其他环境中的初级保健。

DESCRIPTION (provided by applicant): This application proposes to evaluate the first regional roll-out of a unique statewide, multi- stakeholder-based implementation of Patient Centered Medical Home (PCHM) on practice redesign for chronic illness care in Pennsylvania. This is intervention is distinctive with significant multi-payer-based provider incentives facilitated by the PA Governor's Office for Healthcare Reform (GOHCR). This application proposes to study the 25 practices involved in the first of the regions of this statewide initiative, Southeastern PA (SEPA). The SEPA intervention began in May 2008 and includes a 3-year learning collaborative, Improving Performance in Practice (IPIP) practice coaches, and required monthly registry and narrative reports. Significant financial incentives for implementation are paid to providers from the region's major health insurers and are assured by contracts between practices, providers and GOHCR. Varied practice types are included in the collaborative including family medicine, internal medicine, residents, and Federally Qualified Health Center (FQHC) practices varying in size. A multi-method evaluation will include quantitative assessments of clinical outcomes and service utilization and cost, and qualitative approaches will be used to identify unanticipated constructs of interest and obtain perceptions of quality, implementation processes and procedures, and variables that affect PCMH implementation and performance on a daily basis. The goal is understand the impact of this intervention and identify barriers and facilitators for the initiative to help disseminate the process to improve primary care in other settings. PUBLIC HEALTH RELEVANCE: The purpose of this application is to evaluate a multi-stakeholder primary care redesign initiative facilitated by the Pennsylvania Chronic Care Commission focused on improved care for diabetes. The initiative is based on the Patient Centered Medical Home model to coordinate all aspects of patient care and improve patient-physician interaction and satisfaction. The goal is understand the impact of this intervention and identify barriers and facilitators for the initiative to help disseminate the process to improve primary care in other settings.