PA SPREAD: PA Spreading Primary Care Enhanced Delivery Infrastructure

描述（由申请人提供）：以患者为中心的医疗之家（PCMH）已成为改善初级保健服务的变革模式。宾夕法尼亚州（PA）拥有美国最大的多付款人支持的PCMH努力之一，该计划始于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。在我们寻求加强、传播和维持这一转变工作时，巴勒斯坦权力机构倡议背后的大部分基础设施已经存在。一个多利益相关者，政府任命的委员会（代表付款人，供应商，医院，企业，有组织的劳工和州政府）开会计划和监督的倡议。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。超过90%的参与实践正在与国家提高实践绩效计划合作，报告标准化的月度质量成果。PA的利益相关者一致认为，一个合作的，多付款人的方法是必不可少的实践范围内的转型，将实现有形和可衡量的改善护理质量的目标，从而降低护理成本。成功的计划涉及交错的区域推出，包括（1）学习协作/社区，（2）每月绩效报告，（3）具体的转型预期，（4）基于实践的护理管理，（5）实践便利，以及（6）多付款人支持的基础设施付款，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可持续的综合基础设施，随时准备在巴勒斯坦权力机构内外推广。与PA地区健康教育中心（PA AHEC）的全州工作人员和实践网络基础设施合作，将使整个PA的进一步传播，并形成初级保健推广服务的国家模式的基础。我们的整体目标是：（1）加强现有的措施，通过课程开发扩大实践促进，完善学习社区模式，进一步利用信息技术资源进行实践，并与PA AHEC计划合作测试这些创新，以及（2）通过利用AHEC网络传播我们的成功模式和经验教训，以建立一个强大的基础设施，将当前的干预措施推广到所有的PA，利用我们目前的团队对其他州蓬勃发展的全州多利益相关者倡议的持续支持，并将我们的计划打包，有针对性地交付给至少三个其他州。PA的多利益攸关方合作可以作为初级保健推广服务的国家模式，将初级保健转变为PCMH，以改善结果并降低成本。 公共卫生相关性：该应用程序的目的是加强，进一步发展和最终传播现有的初级保健系统，以改变护理和改善结果。该计划基于以患者为中心的医疗之家（PCMH）模式，目前在全州范围内采用152个实践和780个提供者，由一个高度参与的多利益相关者群体驱动，包括付款人，提供者，医院，企业，劳工和州政府。我们的目标是通过完善目前成功的干预措施，扩大实践促进建立一个可持续的计划，并传播宾夕法尼亚州的计划，准备实施或加强自己的PCMH系统的其他国家，以加强现有的基础设施。

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.