North Carolina IMPaCT: Advancing and Spreading Primary Care Transformation

描述（由申请人提供）：北卡罗来纳州（NC）创建了一个全国认可的初级保健重新设计和持续改进项目，作为国家级多部门实践支持的典范。在过去的几年里，我们汇集了一系列高度相互关联的倡议，并将它们建立到现有的全州机构的基础设施中。这个多部门项目继续为初级保健实践、医院和社区提供大量协调一致的支持，同时我们继续改变我们州的医疗保健。NC实践支持计划建立在一个基础广泛和持续的基础设施上，使我们能够扩展到该州的所有实践。北卡罗莱纳社区护理（CCNC）和北卡罗莱纳地区健康教育中心（NCAHEC）这两个全州范围的项目，在实践促进者和“小型协作”的支持下，在持久的区域改进网络中开展初级保健实践。这种结构还使实践能够访问共享的社区资源，以推进对患者的护理。北卡罗莱纳州医疗保健质量联盟（NCHQA）是一个非营利组织，代表该州所有主要的医疗保健利益相关者，作为质量改进计划的协调者和支持者。对于IMPaCT项目，我们将通过开展区域领导力发展计划来加强我们目前的努力，该计划将提高区域医疗和质量改进领导者的有效性。我们还将加强目前以病人为中心的医疗家庭改变方案，将重点放在初级保健在护理环境之间过渡中的作用上。除了在该州进行的几项评估外，我们还将评估CCNC在性能、利用率和护理成本方面的改进速度，以及参与NCAHEC改进网络的时间。因为我们有几种不同的绩效评估方法（多支付方索赔和实践报告的绩效），我们将能够比较不同支付方和方法的结果。最后，该提案的一个主要方面是传播北卡罗来纳州初级保健实践支持模式，以便其他州可以利用我们的经验和教训。我们将与国家卫生政策研究院合作，通过问题简报、NC项目的详细描述以及国家网络研讨会和会议，广泛传播工具和经验。我们还将与3个州密切合作，帮助他们实施自己的多部门初级保健支持工作。

DESCRIPTION (provided by applicant): North Carolina (NC) has created a nationally recognized program of primary care redesign and ongoing improvement that serves as a model of aligned state-level multi-sector practice support. Over the past several years we have pulled together a series of highly interconnected initiatives and built them into the infrastructure of existing statewide institutions. The multi-sector program continues to grow a large and coordinated series of supports for primary care practices, hospitals, and communities as we continue to transform health care in our state. The NC program of practice support is built upon a broad-based and sustained infrastructure that is allowing us to spread to all practices in the state. Two statewide programs, Community Care of North Carolina (CCNC) and the North Carolina Area Health Education Centers (NCAHEC), engage primary care practices in enduring regional improvement networks supported by practice facilitators and 'mini-collaboratives'. This structure also enables practices to access shared community resources to advance care for their patients. The North Carolina Healthcare Quality Alliance (NCHQA), a non-profit organization representing all major healthcare stakeholders in the state, serves as a coordinator and supporter for quality improvement programs. For the IMPaCT project, we will enhance our current efforts by conducting a regional leadership development program that will enhance the effectiveness of the regional medical and quality improvement leaders. We will also enhance our current patient-centered medical home change package to included focused attention on the role of primary care in transitions between care settings. In addition to several ongoing evaluations in the state, we will evaluate the rate of improvement in performance, utilization, and cost of care by duration in CCNC and participation in NCAHEC improvement networks. Because we have several different methods of performance assessment (multiple payer claims and practice reported performance), we will be able to compare results across payer and methodology. Lastly, a major aspect of this proposal is to disseminate the NC primary care practice support model so that other states can take advantage of our experience and lessons learned. We will work with the National Academy for State Health Policy to disseminate tools and experiences broadly through issue briefs, detailed descriptions of the NC programs, and national webinars and conferences. We will also work intensively with 3 states to help them implement their own multi-sector primary care support efforts. PUBLIC HEALTH RELEVANCE: North Carolina has developed a nationally recognized statewide primary care transformation and improvement support program that is a model for other states. This project will lead to enhancements and evaluation of the North Carolina program and dissemination of the model to other states. Such primary care support programs can demonstrate improved quality of health care, lower costs, and better health outcomes.