Strategies for Improving the Quality of Preventive Services in Primary Care

描述（由申请人提供）：吸烟、危险饮酒、不良饮食和缺乏身体活动是许多慢性疾病的危险因素，也是目前美国可预防的死亡和残疾的主要原因。根据美国预防服务工作组（U.S. preventive Services Task Force）的说法，减少疾病和残疾的最有效干预措施之一是关注患者的个人健康习惯。虽然初级保健实践在改善患者健康方面处于有利地位，但这些机会往往被错过。本研究的目的是研究如何利用改善初级保健环境质量的策略来增加这些机会。这项研究的动机是我的职业目标，即进行严谨的研究，为实践、提供者和患者层面的变革提供信息，以改善医疗服务流程和健康结果。目前的提案与国家研究议程一致，旨在通过改善医疗系统多层次的交付结构和流程来提高医疗质量。在本提案中，我将追求以下目标：1)评估慢性护理模式作为一种系统重新设计策略，以改善预防性护理流程和患者结果，如健康风险行为和生活质量；2)检查绩效薪酬作为一种财务策略，以提高以预防为导向的实践结构、护理过程和患者结果的质量；3)评估团队合作和员工参与决策作为质量预防措施管理策略的影响；4)评估一项旨在提高行为干预质量的国家倡议的外部有效性，并描述参与这一基于实践的研究的促进因素和障碍；5)对项目进行可持续性研究，并建议在临床实践中维持已证实的干预措施的策略，即将研究转化为实践。提出的研究将实证检验的概念模型，已建议改善医疗保健结构，过程和结果。计划中的研究将利用从资助AHRQ基于实践的研究网络的国家倡议中收集的横截面和纵向数据，以开发现实世界初级保健实践中的行为改变干预措施。将使用混合方法，包括根据拟议的职业发展计划将获得的新的定性研究技术和先进的定量方法。

DESCRIPTION (provided by the applicant): Tobacco use, risky drinking, poor diet, and physical inactivity are risk factors for many chronic diseases, and are currently the nation's leading causes of preventable death and disability. According to the U.S. preventive Services Task Force, among the most effective interventions for reducing disease and disability are those that address patients' personal health habits. While primary care practices are well-positioned to improve patient health, these opportunities are often missed. The purpose of this research is to examine how these opportunities can be enhanced using strategies for quality improvement in primary care settings. This research is motivated by my career goals of conducting rigorous research that informs change at the practice, provider, and patient levels to improve care delivery processes and health outcomes. The current proposal is aligned with a national research agenda to improve healthcare quality by improving delivery structures and processes at multiple levels of the healthcare system. In this proposal, I will pursue the following aims: 1) evaluate the Chronic Care Model as a system redesign strategy to improve preventive care processes and patient outcomes such as health risk behaviors and quality of life; 2) examine pay for performance as a financial strategy to improve the quality of prevention-oriented practice structures, care processes, and patient outcomes; 3) assess the impact of teamwork and staff participation in decision making as management strategies for quality initiatives in prevention; 4) evaluate the external validity of a national initiative to improve the quality of behavioral interventions, and describe facilitators and barriers to participating in this practice-based research; 5) conduct a sustainability study of projects and recommend strategies for maintaining proven interventions in clinical practice, i.e., for translating research into practice. The proposed research will empirically examine conceptual models that have been recommended for improving healthcare structures, processes, and outcomes. Planned studies will leverage both cross sectional and longitudinal data gathered from a national initiative funding AHRQ practice-based research networks to develop behavior change interventions in real-world primary care practices. Mixed methodology will be used, including new qualitative research techniques and advanced quantitative methods that will be acquired as a result of the proposed career development plan.