PA SPREAD: PA Spreading Primary Care Enhanced Delivery Infrastructure

PA SPREAD：PA 传播初级保健，增强交付基础设施

• 批准号: 8227012
• 负责人: ROBERT A GABBAY
• 金额: $ 48.18万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8227012
• 关键词: PA; SPREAD; Spreading; Primary; Care

DESCRIPTION (provided by applicant): The Patient Centered Medical Home (PCMH) has emerged as a transformative model to improve primary care delivery. Pennsylvania (PA) has one of the largest multi-payer-supported PCMH efforts to transform primary care in the U.S. The initiative started in 2008, is led by state government, and involves 152 primary care practices (75% with fewer than 5 provider FTEs), 780 providers, 17 of the state's largest commercial and Medicaid plans. As we look to enhance, disseminate and sustain this transformation work, much of the infrastructure behind the PA initiative already exists. A multi-stakeholder, government-appointed commission (representing payers, providers, hospitals, business, organized labor, and state government) meets to plan and oversee the initiative. Commission has helped drive dissemination of the initiative statewide with improved clinical outcomes. More than 90% of the participating practices are reporting standardized monthly quality outcomes in partnership with the national Improving Performance in Practice program. PA's stakeholders have agreed that a collaborative, multi-payer approach is essential to practice-wide transformation that will achieve the goals of tangible and measurable improvement in the quality of care, leading to a reduction in the costs of care. The successful initiative has involved staggered regional rollouts that include (1) learning collaborative/communities, (2) monthly performance reporting, (3) specific transformation expectations, (4) practice-based care management, (5) practice facilitation, and (6) multi-payer supported infrastructure payments to drive PCMH adoption. The project goal is to build on success with an integrated sustainable infrastructure that is ready to be disseminated throughout PA and beyond. Partnering with the statewide staffing and practice network infrastructure of PA Area Health Education Center (PA AHEC) will enable further dissemination across PA and form the basis for a national model for the primary care extension service. Our overall objectives are to (1) Enhance the current initiative by expanding practice facilitation through curriculum development, refining the learning community model, further leveraging IT resources into practices, and testing these innovations in partnership with the PA AHEC program and (2) Disseminate our successful models and lessons learned by harnessing the AHEC network to establish a robust infrastructure to spread the current intervention across all of PA, leveraging our current team's ongoing support for burgeoning statewide multi-stakeholder initiatives in other states, and package our program for targeted delivery to at least three other states. PA's multi-stakeholder collaboration can serve as a national model for the primary care extension service to transform primary care towards PCMH to improve outcomes and lower costs. PUBLIC HEALTH RELEVANCE: The purpose of this application is to enhance, further develop and ultimately disseminate the existing primary care system to transform care and improve outcomes. This initiative is based on the Patient Centered Medical Home (PCMH) model, currently employed across the state with 152 practices and 780 providers driven by a highly engaged multi-stakeholder group that includes payers, providers, hospitals, businesses, labor and state government. The goal is to enhance the existing infrastructure by refining the current successful interventions, expanding practice facilitation to build a sustainable plan, and disseminating Pennsylvania's plan to other states that are ready to implement or strengthen their own PCMH system.

描述（由申请人提供）：以患者为中心的医疗之家（PCMH）已经成为改善初级保健服务的变革模式。宾夕法尼亚州（PA）是美国最大的由多方支付者支持的PCMH改造初级保健的努力之一。该倡议始于2008年，由州政府领导，涉及152个初级保健实践（75%少于5个提供者fte）， 780个提供者，17个州最大的商业和医疗补助计划。当我们希望加强、传播和维持这一转型工作时，PA倡议背后的大部分基础设施已经存在。由政府任命的多方利益相关者委员会（代表付款人、提供者、医院、企业、有组织的劳工和州政府）开会规划和监督该倡议。委员会帮助推动了该倡议在全州范围内的传播，改善了临床结果。90%以上的参与实践与国家实践绩效改善项目合作，每月报告标准化的质量结果。PA的利益相关者一致认为，协作、多支付方的方法对于实践范围内的转型至关重要，这将实现医疗质量的切实和可衡量的改善目标，从而降低医疗成本。成功的计划涉及到交错的区域推出，包括(1)学习协作/社区，(2)月度绩效报告，(3)具体的转型期望，(4)基于实践的护理管理，(5)实践促进，以及(6)多付款人支持的基础设施支付，以推动PCMH的采用。该项目的目标是在成功的基础上建立一个综合的可持续基础设施，准备在整个巴勒斯坦地区和其他地区传播。与PA地区健康教育中心（PA AHEC）的全州人员配备和实践网络基础设施合作，将使该方案能够在PA进一步传播，并形成初级保健扩展服务的全国模式的基础。我们的总体目标是：(1)通过课程开发扩大实践便利，完善学习社区模式，进一步利用IT资源进行实践，并与PA AHEC项目合作测试这些创新，从而增强当前的主动性；(2)通过利用AHEC网络建立强大的基础设施，将我们的成功模式和经验教训传播到所有PA。利用我们目前的团队对其他州蓬勃发展的全州多方利益相关者倡议的持续支持，并将我们的计划包装为至少三个其他州的目标交付。PA的多方利益相关者合作可以作为初级保健扩展服务的国家模式，将初级保健转变为PCMH，以改善结果和降低成本。