A Study of the Patient-Centered Medical Home: Lessons from a New York State Commu

描述(由申请人提供)：家庭健康研究所在纽约州运营着一个由16个联邦合格社区健康中心组成的多样化网络，建议对其向以患者为中心的家庭护理模式(PCMH)的转变的实施和影响进行多方法研究。这种模式在提高医疗质量和吸引患者方面具有很高的潜力。这项研究的研究团队包括纽约医学院和德雷克塞尔大学的研究所负责人和合作伙伴。这项研究的目的是向儿童健康中心和初级保健做法提供信息，说明他们努力采用PCMH模式的情况。 具体项目目标是： *确定并描述护理过程、其财务成本和其他资源需求； *审查和验证卫生服务利用率和患者结果的变化，重点是糖尿病、抑郁症和高脂血症，这些变化是由于实施PCMH模式而造成的；以及 *阐述研究所及其个别保健中心内影响实施PCMH模式和改善护理的组织、背景、程序和其他变量。 研究设计：这项研究将包括从研究所的电子健康记录系统收集的个人、提供者和站点数据；对患者、管理人员、提供者和工作人员的深入访谈；以及对二手来源文件的审查。将使用定性方法来确定实施过程、工作流程变化、对变化的看法、资源需求、背景因素以及系统、个人和现场一级做法变化之间的联系和途径。量化方法将侧重于符合PCMH标准的实践变化的衡量标准、患者层面服务利用的变化、健康结果的改善以及与这些变化相关的成本。 公共卫生相关性：家庭健康研究所在纽约州运营着一个由16个联邦合格社区卫生中心组成的多样化网络，该研究所提议对其向以患者为中心的家庭护理模式(PCMH)的转变的实施和影响进行严格的多方法研究。尽管证据有限，但PCMH模式被视为具有提高医疗质量和吸引患者的高潜力，该模式和相关补偿激励措施的采用正在加速。研究结果将为儿童健康中心和其他基层保健服务机构在努力采用PCMH模式时所做的努力提供信息。

DESCRIPTION (provided by applicant): The Institute for Family Health, which operates a diverse network of 16 federally-qualified community health centers in New York State, proposes to conduct a multi-method study of the implementation and impact of its transformation to a patient-centered home model of care (PCMH). This model has high potential to improve health care quality and engage patients. The study's research team includes Institute leaders and partners at the New York Academy of Medicine and Drexel University. The goal of the study is to inform the efforts of CHCs and primary care practices as they strive to adopt the PCMH model. Specific project aims are to: * Identify and describe processes of care, their financial costs, and other resource requirements; * Examine and validate changes in health service utilization and outcomes among patients, with a focus on diabetes, depression and hyperlipidemia, that resulted from the implementation of the PCMH model; and * Explicate the organizational, contextual, procedural and other variables within the Institute and its individual health centers that impacted on the implementation of the PCMH model and improvements in care. Research Design: This study will incorporate individual, provider and site data collected from the Institute's electronic health record system; in-depth interviews with patients, administrators, providers and staff; and reviews of secondary source documents. Qualitative methods will be used to identify implementation processes, workflow changes, perceptions of change, resource requirements, contextual factors, and linkages and pathways between system, individual and site level practice change. Quantitative methods will focus on measures of change in practice consistent with PCMH standards, changes in service utilization at the patient level, improvements in health outcomes, and costs associated with these changes. PUBLIC HEALTH RELEVANCE: The Institute for Family Health, which operates a diverse network of 16 federally-qualified community health centers in New York State, proposes to conduct a rigorous multi-method study of the implementation and impact of its transformation to a patient-centered home model of care (PCMH). Despite limited evidence, the PCMH model is viewed as having high potential to improve health care quality and engage patients, and uptake of the model and related reimbursement incentives is accelerating. The study findings will inform the efforts of CHCs and other primary care practices as they strive to adopt the PCMH model.