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经营着一个由16个联邦合格社区卫生中心组成的多元化网络，建议对其向以患者为中心的家庭护理模式（PCMH）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大的潜力。该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领导和合作伙伴。这项研究的目的是告知社区卫生中心和初级保健实践的努力，因为他们努力采用PCMH模式。 项目的具体目标是： * 确定和描述护理过程、其财务成本和其他资源需求; * 检查和验证病人的卫生服务利用和结果的变化，重点是糖尿病，抑郁症和高脂血症，这是由于实施PCMH模式; * 阐述研究所及其各个健康中心内的组织、背景、程序和其他变量，这些变量影响了PCMH模型的实施和护理的改善。 研究设计：这项研究将纳入从研究所电子健康记录系统收集的个人，提供者和网站数据;与患者，管理人员，提供者和工作人员的深入访谈;以及对二级源文件的审查。定性方法将用于确定实施过程、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。定量方法将侧重于与PCMH标准一致的实践变化的措施，患者水平的服务利用变化，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经营着一个由16个联邦合格社区卫生中心组成的多元化网络，该研究所建议对其向以患者为中心的家庭护理模式（PCMH）转型的实施和影响进行严格的多方法研究。尽管证据有限，但PCMH模式被认为具有提高医疗质量和吸引患者的巨大潜力，该模式和相关报销激励措施的采用正在加速。研究结果将为社区卫生中心和其他基层医疗机构努力采用PCMH模式提供信息。

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.