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Primary Care Transformation in a NCQA Certified Patient-Centered Medical Home

NCQA 认证的以患者为中心的医疗之家的初级保健转型

基本信息

批准号：
8123369
负责人：
MING TAI-SEALE
金额：
$ 30万
依托单位：
PALO ALTO MEDICAL FOUNDATION RES INST
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-10 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8123369
关键词：
Primary Care Transformation NCQA Certified

项目摘要

DESCRIPTION (provided by applicant): We apply for funding for an R18 study in response to AHRQ's RFA-HS-10-002, Transforming Primary Care Practice. While leading professional societies have identified principles for restructuring primary health care in the Patient Centered Medical Homes (PCMH), the PCMH model remains largely an aspiration. The Palo Alto Medical Foundation (PAMF) is a large physician-led nonprofit multispecialty ambulatory care system in Northern California and an ideal setting to conduct a rigorous study of on-going, successful efforts to transform primary care delivery. First, PAMF has been implementing components of PCMH since 1999 and all three of PAMF's divisions have been certified by NCQA's Physician Practice Connection as Patient-Centered Medical Homes since 2006. Second, being a large multi-specialty practice with a multitude of payers and hang physicians whose compensation reflects FFS incentives make lessons from PAMF applicable to a wide range of health care delivery settings. Third, the diversity of PAMF in terms of practice size (from 3 to 300 physicians), payer mix (30% capitation and 70% fee-for-service), culture, location, and heterogeneous patient population provide the variability one needs to assess the effects of interventions. All PAMF clinics use the same EpicCare Electronic Health Record (EHR) allowing uniform assessments across sites. Finally, the PAMF Research Institute has a team of experienced investigators with direct access to data, medical leadership, and patients, yet freedom to publish all findings. In this project, we will obtain robust and detailed information about the actual primary care transformation processes - retrospective and concurrent - and the lessons learned by PAMF in its successful endeavors to transform primary care. The specific aims are to: (1) describe methods used to transform practices, with attention to the organizational context and culture and conditions within which changes have occurred. We will perform in-depth key informant interviews with decision makers at different levels of the organization including senior executives, quality improvement committee members, and frontline care team members including physicians and nurses. Qualitative data collection and analysis will follow the Grounded Theory approach. (2) Assess the changes in processes (e.g., same day appointments), intermediate clinical outcomes (e.g., blood pressure, HbA1c, and lipids for diabetes patients), and costs and efficiency of care (e.g., inpatient readmissions, emergency department visits, effective "panel" size that accounts for differences in patient need). Empirical approaches range from key informant interviews, focus group, to a retrospective quantitative quasi-experimental study with data drawn from EpicCare EHR, IDX scheduling, and billings data. (3) Determine the impact of the transformative processes on the actual experiences and satisfaction of physicians, staff, and patients. Key informant interviews and focus groups data collected for this study will be leveraged with routinely collected past and ongoing surveys undertaken by the organization. Insights learned from PAMF will inform future PCMHs elsewhere and policy makers in need of empirical evidence in developing PCMH payment and administrative policies. PUBLIC HEALTH RELEVANCE: Leading medical professional societies have identified Patient Centered Medical Homes (PCMH) as a key to revive primary care in the United States, even though the PCMH model remains largely an aspiration nation- wide. The Palo Alto Medical Foundation (PAMF) is a large physician-led nonprofit multispecialty ambulatory care system in Northern California and an ideal setting to conduct the proposed study. Researchers will use robust and detailed qualitative and quantitative information about the actual primary care transformation processes - retrospective and concurrent - and the lessons learned by PAMF in its successful endeavors to transform primary care. Insights learned from the study will inform future PCMHs elsewhere and policy makers in need of empirical evidence in developing PCMH payment and administrative policies.

描述（由申请人提供）：我们申请资助一项R18研究，以响应AHRQ的RFA-HS-10-002，转变初级保健实践。虽然主要的专业协会已经确定了以病人为中心的医疗之家（PCMH）的初级卫生保健重组原则，但PCMH模式在很大程度上仍然是一种愿望。帕洛阿尔托医学基金会（PAMF）是北加州一个由医生领导的大型非营利性多专业门诊护理系统，是对正在进行的、成功转变初级保健服务的努力进行严格研究的理想场所。首先，PAMF自1999年以来一直在实施PCMH的组成部分，自2006年以来，PAMF的所有三个部门都获得了NCQA医师实践连接的认证，成为以患者为中心的医疗之家。其次，作为一个拥有众多支付方和医生的大型多专业实践，其薪酬反映了FFS激励措施，因此PAMF的经验教训适用于广泛的卫生保健提供环境。第三，PAMF在实践规模（从3到300名医生）、付款人组合（30%的收费和70%的服务收费）、文化、地点和异质患者群体方面的多样性提供了评估干预措施效果所需的可变性。所有PAMF诊所都使用相同的EpicCare电子健康记录（EHR），允许跨站点进行统一的评估。最后，PAMF研究所拥有一支由经验丰富的研究人员组成的团队，他们可以直接访问数据、医疗领导和患者，但可以自由发表所有研究结果。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Nudging physicians and patients with autopend clinical decision support to improve diabetes management.

通过自动挂起的临床决策支持推动医生和患者改善糖尿病管理。

DOI：
发表时间：
2018
期刊：
The American journal of managed care
影响因子：
0
作者：
Panattoni,Laura;Chan,Albert;Yang,Yan;Olson,Cliff;Tai-Seale,Ming
通讯作者：
Tai-Seale,Ming

Why do we observe a limited impact of primary care access measures on clinical quality indicators?

为什么我们观察到初级保健获取措施对临床质量指标的影响有限？

DOI：
10.1097/jac.0000000000000026
发表时间：
2014
期刊：
The Journal of ambulatory care management
影响因子：
0
作者：
Chung,Sukyung;Panattoni,Laura;Hung,Dorothy;Johns,Nicole;Trujillo,Laurel;Tai-Seale,Ming
通讯作者：
Tai-Seale,Ming

Features of Patient-Centered Primary Care and the Use of Ambulatory Care.

以患者为中心的初级保健的特点和门诊护理的使用。

DOI：
10.1089/pop.2016.0079
发表时间：
2017
期刊：
Population health management
影响因子：
2.5
作者：
Wong,Paul;Panattoni,Laura;Tai-Seale,Ming
通讯作者：
Tai-Seale,Ming

Recognition as a Patient-Centered Medical Home: Fundamental or Incidental?

DOI：
10.1370/afm.1488
发表时间：
2013-05-01
期刊：
ANNALS OF FAMILY MEDICINE
影响因子：
4.4
作者：
Dohan, Daniel;McCuistion, Mary Honodel;Tai-Seale, Ming
通讯作者：
Tai-Seale, Ming

Leveraging electronic health records to develop measurements for processes of care.

利用电子健康记录来开发护理过程的测量方法。

DOI：
10.1111/1475-6773.12126
发表时间：
2014
期刊：
Health services research
影响因子：
3.4
作者：
Tai-Seale,Ming;Wilson,CarolineJ;Panattoni,Laura;Kohli,Nidhi;Stone,Ashley;Hung,DorothyY;Chung,Sukyung
通讯作者：
Chung,Sukyung