Understanding the Transformation Experiences of Small Practices with NCQA's Med

描述（由申请人提供）：以患者为中心的医疗之家（PCMH）的概念作为一种改善护理的潜在手段正在受到越来越多的关注。支付方、购买者和政策制定者将其视为降低成本和提高质量的工具，部分是通过振兴初级保健来实现的。了解小型实践的实践转变可以帮助我们加快PCMH的采用，因为这个国家绝大多数的初级保健都是通过小型实践提供的，然而迄今为止大多数关于质量改进的研究都集中在大型医疗集团上。我们建议通过NCQA的医师实践联系(R)-以患者为中心的医疗之家（PPC(R)-PCMH）计划获得认可，利用已经证明实施PCMH模式的国家实践清单。这些标准是根据研究、咨询小组、试点测试和公众意见制定的，并得到了国家质量论坛、众多医生组织和利益攸关方的认可，作为PCMH示范项目合格做法的标准化工具。在获得认可的诊所中，超过一半的医生少于5人。这些小诊所分布在14个不同的州，在规模、所有权和服务的患者群体方面各不相同。基于我们与领先研究人员在质量改进方面的持续合作，我们将：1)详细介绍成功实施PCMH模式（基于三级PPC-PCMH认可的成就）并代表不同州、组织特征、PCMH示范项目和患者群体的小型医师实践的转变过程；2)在代表不同州、组织特征、示范项目和患者群体的300个小型实践中，识别组织和环境因素，这些因素将PCMH实施水平较高的实践（基于3级识别）与实施水平较低的实践（1或2级）区分开来；3)比较300个小诊所的医师经验，这些小诊所的PCMH实施水平较高和较低；4)比较300个实施PCMH水平较高和较低的小型实践的运营成本和收入。我们将使用10个实践的有目的样本的案例研究来收集关于转型过程的定性和定量信息，并确定变革的关键障碍和支持。然后，我们将对全国300个具有PPC-PCMH认可的小型实践进行调查，以获得有关实践转型的更普遍的知识。这项研究将提供一个前所未有的视角来研究支持在小型实践中实施PCMH的因素，并使我们能够确定对成功实施PCMH至关重要的支持类型，以及对实践成本/收入和医生工作经验的影响。由于NCQA与多个利益相关者的紧密联系，我们有一个独特的机会向全国观众传播这些发现，并利用这些结果为我们的项目提供信息。

DESCRIPTION (provided by applicant): The concept of a Patient-Centered Medical Home (PCMH) is receiving increased attention as a potential means to improve care. Payers, purchasers, and policy makers see it as a vehicle for moderating costs and improving quality, in part through revitalizing primary care. Understanding practice transformation in small practices can help us accelerate the adoption of the PCMH, since the vast majority of primary care in this country is provided through small practices, yet most of the research to date on quality improvement has focused on large medical groups. We propose to take advantage of a national list of practices that have demonstrated implementation of PCMH model by achieving recognition through NCQA's Physician Practice Connections(R)--Patient-Centered Medical Home" (PPC(R)-PCMH) program. These standards were developed from research, advisory groups, pilot tests and public comment and are endorsed by the National Quality Forum, numerous physician organizations, and stakeholders as a standardized tool for qualifying practices for PCMH demonstration projects. Over half of the practices that have achieved recognition have fewer than 5 physicians. These small practices are located in 14 different states and vary in size, ownership, and patient populations served. Building on our ongoing collaboration with leading researchers on quality improvement, we will: 1) Detail the transformation process among small physician practices that have successfully implemented the PCMH model (based on achievement of Level 3 PPC-PCMH recognition) and that represent diverse states, organizational characteristics, PCMH demonstration programs, and patient populations; 2) Identify organizational and contextual factors that distinguish practices with a higher level of PCMH implementation (based on Level 3 recognition) compared to those with lower levels of implementation (Level 1 or 2) among 300 small practices representing diverse states, organizational characteristics, demonstration programs, and patient populations; 3) Compare physician experiences among 300 small practices with higher versus lower levels of PCMH implementation; and 4) Compare operational costs and revenue among 300 small practices with higher versus lower levels of PCMH implementation. We will use case studies of a purposive sample of 10 practices to gather both qualitative and quantitative information on the process of transformation as well as to identify key barriers and supports for change. We will then conduct a national survey of 300 small practices with PPC-PCMH recognition to gain more generalizable knowledge about practice transformation. This study will provide an unprecedented look at the factors that support PCMH implementation in small practices, and will allow us to identify the types of supports that are critical to successful PCMH implementation as well as the impact on practice costs/revenues and physician work experiences. With NCQA's strong ties to multiple stakeholders, we have a unique opportunity to disseminate these findings to a national audience and to use the results to inform our programs. PUBLIC HEALTH RELEVANCE: Payers, purchasers, and policy makers see the Patient-Centered Medical Home as a vehicle for moderating costs and improving quality, in part through revitalizing primary care. This study pairs 10 case studies with a national survey of 300 small practices that have implemented the medical home to explore the transformation process. This study will provide an unprecedented look at the factors that support PCMH implementation in small practices, and it will allow us to identify the types of financial and other supports that are critical to successful PCMH implementation as well as the relationship of PCMH implementation to practice costs/revenues and physician work experiences.