Transforming Primary Care Practice in North Carolina

描述（由申请人提供）：以病人为中心的医疗之家（PCMH）模式涉及到完整的初级保健实践的重新设计，其最终目标是提高病人护理的质量和降低成本。需要关于实践转换的最佳方法的详细信息，以帮助计划完成此过程的越来越多的实践。本研究的总体目标是评估北卡罗来纳实践绩效改善项目（NC IPIP）基层医疗实践中转型变革的采用和过程，检查变革的具体组成部分如何与关键健康结果相关，并探索有利于转型变革的环境、组织和财务条件。本研究的目的是1)确认在NC IPIP的40个选定实践中发生的转型变革过程，2)评估变革的哪些组成部分与糖尿病和哮喘的质量护理指标的改善最相关，3)对于12个实践的子集，证明在实施转型变革方面取得了不同程度的成功，利用定量和定性方法来获得对变革过程的更丰富的理解。检查环境条件、组织特征和财务资源对变革过程的影响，并描述实践层面的转型变革所涉及的成本，4)提供一套可应用于个人实践层面和卫生保健组织层面的建议，以协助PCMH转型过程。本研究的最终目标和意义是描述转型过程，并得出一组可实施的建议，这些建议可以广泛分享，以帮助个人实践和卫生保健组织转向PCMH模式。

DESCRIPTION (provided by applicant): The Patient-Centered Medical Home (PCMH) model involves complete primary care practice redesign with the ultimate goal to improve the quality of patient care and reduce cost. Detailed information on the best methods of practice transformation is needed to help the growing number of practices as they plan to go through this process. The overall objective of this study is to evaluate the adoption and process of transformational change in primary care practices belonging to the North Carolina Improving Performance in Practice program (NC IPIP), examine how specific components of the change relate to key health outcomes and explore environmental, organizational and financial conditions that are conducive to transformational change. The aims of this study are to 1) confirm the transformational change process that has occurred within 40 selected practices in the NC IPIP, 2) evaluate which components of change are most linked with improvement in the quality care indicators for diabetes and asthma, 3) for a subset of 12 practices that evidence varying degrees of success in implementing transformational change, utilize quantitative and qualitative methods to obtain a richer understanding of the change process, examine the effect of environmental conditions, organizational characteristics and financial resources on the change process and describe the costs involved in transformational change at the practice level, and 4) provide a set of recommendations that can be applied at the individual practice level and at the health care organization level to assist in the PCMH transformation process. The ultimate goal and the significance of this study is to describe the transformation process and arrive at a set of implementable recommendations that can be shared broadly to assist individual practices and health care organizations moving toward the PCMH model. PUBLIC HEALTH RELEVANCE: The Patient-Centered Medical Home (PCMH) describes a health care setting that facilitates partnerships between individual patients and their personal physicians. The PCMH model improves patient access to care and quality of care. In this study, the researchers plan to evaluate the adoption and process of this transformational change and examine how specific components of the change relate to key health outcomes. This project is highly relevant to public health as it will enhance understanding of the transformation process in practice and provide a set of implementable recommendations that can be shared broadly to assist individual practices and health care organizations moving toward the PCMH model.