A Multi-payer Patient Centered Medical Home Initiative in Pennsylvania

描述（由申请人提供）：本申请旨在评价宾夕法尼亚州慢性病护理实践重新设计中以患者为中心的医疗之家（PCHM）在全州范围内的首次区域推广，该实施以多个患者为基础。这一干预措施与巴勒斯坦权力机构总督保健改革办公室（GOHCR）推动的以多付款人为基础的重要提供者激励措施不同。该应用程序建议研究全州范围内的第一个地区，东南PA（SEPA）所涉及的25种做法。SEPA干预始于2008年5月，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。该区域主要健康保险公司向提供者支付了实施的重大财政奖励，并通过实践、提供者和GOHCR之间的合同予以保证。不同的实践类型包括在合作，包括家庭医学，内科，居民，和联邦合格的健康中心（WHC）的做法不同的大小。多方法评价将包括临床结局和服务利用率和成本的定量评估，定性方法将用于识别非预期的感兴趣结构，并获得对质量、实施过程和程序以及影响PCMH实施和日常表现的变量的看法。我们的目标是了解这种干预的影响，并确定该倡议的障碍和促进因素，以帮助传播在其他环境中改善初级保健的过程。 公共卫生相关性：该应用程序的目的是评估由宾夕法尼亚州慢性病护理委员会推动的多利益相关者初级保健重新设计倡议，重点是改善糖尿病护理。该倡议基于以患者为中心的医疗之家模式，以协调患者护理的各个方面，并改善患者与医生的互动和满意度。我们的目标是了解这种干预的影响，并确定该倡议的障碍和促进因素，以帮助传播在其他环境中改善初级保健的过程。

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.