Medical Home Transformation in Pediatric Primary Care - What Drives Change

描述(由申请人提供)：儿科初级保健中的医疗之家转型--什么驱动变化研究将确定医疗之家转型的驱动因素和障碍，以及10个转型后的初级保健儿科家庭为中心的医疗之家(FCMH)的可持续性。长期目标包括：1)确定影响转型的关键内部和外部因素；2)描述用于维持转型的业务模式；3)评估便利化、技术援助和其他质量改进支持的贡献；4)评估转型对工作人员、患者和家庭的影响；5)找出儿科医疗之家和儿科实践转型与成人护理模式相比的独特特点；6)向多个利益相关者传达研究结果，包括实践、政策制定者、付款人、家庭、医学教育工作者和培训计划。根据合作前和协作后的医疗之家指数(MHI)得分的改善，从2003至2006年间参加为期两年的国家医疗之家学习合作中表现最好的实践中，确定了10个转变后的儿科实践和3个候补实践。所有实践将完成CMHI TAPPP差距分析工具，该工具包括MHI并在多个维度上评估医疗房屋质量，包括为NCQA认证做好准备。一个流动研究小组将审查TAPPP数据，然后访问所有十个实践，对关键实践工作人员和患有和不患有慢性病的儿童的父母进行多次半结构化访谈。TAPPP得分最高的五个做法将提供与护理质量有关的额外量化数据，包括150个图表审计和每个做法对30个家庭进行的CAHPS 2次调查。面试结果的分析将使用NVivo 8软件进行主题分析。将对量化调查和图表审计数据进行分析，以确定质量指标，这些指标将纳入对五个高绩效做法的访谈的分析。结果将通过与美国儿科学会及其国家医疗之家实施中心的合作伙伴关系传播。 公共卫生相关性：这项研究的相关性与这样一种普遍信念有关，即转变后的初级保健不仅将产生更好的健康结果，还将降低成本并增加初级保健职业的吸引力。这项研究将在主要侧重于成人保健的医疗之家转型运动的背景下，加强对转变儿科护理和维持以儿科家庭为中心的医疗之家所需因素的理解。

DESCRIPTION (provided by applicant): The Medical Home Transformation in Pediatric Primary Care - What Drives Change study will identify the drivers and obstacles to medical home transformation and to the sustainability of change in 10 transformed primary care pediatric family-centered medical homes (FCMH). The long-term objectives include: 1) identify key internal and external factors affecting transformation; 2) describe the business models used to sustain transformation; 3) evaluate the contribution of facilitation, technical assistance, and other quality improvement supports; 4) assess transformation's impact on staff, patients, and families; 5) identify characteristics unique to the pediatric medical home and pediatric practice transformation compared to the adult care models; 6) communicate findings to multiple stakeholders included practices, policy makers, payers, families, and medical educators and training programs. Ten transformed pediatric practices and three alternates were identified from among the highest performing practices in taking part in two yearlong national medical home learning collaboratives between 2003 and 2006 based on improvements between their pre- and post-collaborative Medical Home Index (MHI) scores. All practices will complete the CMHI TAPPP gap analysis tool, which includes the MHI and assesses medical home qualities on a number of dimensions including readiness for NCQA recognition. A traveling study team will review the TAPPP data and then visit all ten practices to conduct multiple semi-structured interviews with key practice staff and parents of children with and without chronic conditions. The five practices with the highest TAPPP scores will provide additional quantitative data related to quality of care including 150 chart audits and CAHPS 2 surveys of 30 families from each practice. Analysis of interview results will be subjected to a thematic analysis using NVIVO 8 software. Quantitative survey and chart audit data will be analyzed for indicators of quality that will be incorporated into the analysis of the interviews from the five high- performing practices. Results will be disseminated through a partnership with the American Academy of Pediatrics and its National Center for Medical Home Implementation. PUBLIC HEALTH RELEVANCE: The relevance of this study pertains to the widespread belief that transformed primary care will not only produce improved health outcomes, but also reduce costs and increase the attractiveness of careers in primary care. This study will enhance understanding of the factors needed to transform pediatric care and sustain a pediatric family-centered medical home in the context of a medical home transformation movement that has been largely focused on adult health care.