Identifying Best Practices of Medical Home Implementation for Older Adults

描述（由申请人提供）：拟议的研究探讨了初级保健提供者（PCP）和护士如何在实践中为老年人实施以患者为中心的医疗之家原则（PCMH）。它需要一个定性的方法，探索PCP和护士的经验与PCMH照顾老年人，并在确定提供者的信念，知识和学习这些经验产生的。然后，该研究将确定的经验，信念，知识和学习与提供者在试图更有效地向老年患者提供一个或多个PCMH护理原则时参与的特定策略，方法和活动联系起来。这些“实施最佳实践”将根据具体的PCMH原则进行分类，并可以在进行家庭医疗护理的初级保健工作环境中进一步验证和应用。共有60名PCP和护士将接受该项目的采访。此外，两个重点小组的PCP和护士将举行，以帮助验证和完善访谈结果。这项探索性研究的最终产品是双重的：（a）丰富的日常经验的描述，知识的收获，和学习积累的一组PCP和护士做PCMH护理老年人，和（B）类别的实施最佳实践（战略，方法和活动），可能会改善PCMH护理提供老年人。这项研究在几个方面具有创新性。首先，它是由一个普遍的概念驱动的，即没有一个“一刀切”的方法来实现PCMH。这证明了核心重点是获得有关PCP的知识和护士经验，为重要的患者亚组实施金标准PCMH原则。这一领域的大部分现有研究尚未研究该模型在特定患者亚群（如老年人）中的实施经验。因此，该项目填补了一个必要的经验差距，确定PCMH实施的最佳做法，是密切配合的独特需求和特点的老年人获得初级保健服务。此外，研究方法是新颖的，因为它适用于社会心理学，机构为基础的角度对如何思考医疗家庭的实施和测量的问题。这将是第一个已知的研究，以检查PCMH的实施和测量的角度来看，日常的社会互动和交流之间发生的初级保健提供者和他们的老年患者。它的社会学取向补充了研究PCMH的研究人员主要使用的经济和结构视角，以这种方式为我们对PCMH实施的理解增加了新的知识。从应用的角度来看，通过访谈数据产生的丰富描述以及由此确定的实施最佳实践将传播给从事PCMH护理的其他组织。然后，这些组织可以利用这些知识来改进自己的PCMH实施过程。

DESCRIPTION (provided by applicant): The proposed study examines how primary care providers (PCP) and nurses implement patient-centered medical home principles (PCMH) for older adults in their practices. It takes a qualitative approach in exploring PCP and nurse experiences with PCMH care for older adults, and in identifying provider beliefs, knowledge, and learning produced by these experiences. The study then links the experiences, beliefs, knowledge, and learning identified to specific strategies, approaches, and activities in which providers engage when attempting to provide one or more PCMH care principles more effectively to their older adult patients. These "implementation best practices" will be categorized by specific PCMH principle and can be validated and applied further across primary care work settings doing medical home care. A total of sixty PCPs and nurses will be interviewed for the project. In addition, two focus groups of PCPs and nurses will be held to help validate and refine the interview findings. The end product of this exploratory study is two-fold: (a) rich description of the everyday experiences, knowledge gains, and learning accumulation for a group of PCPs and nurses doing PCMH care for older adults, and (b) categories of implementation best practices (strategies, approaches, and activities) that could potentially improve PCMH care delivery for older adults. The study is innovative in several ways. First, it is driven by the general notion that there is not a "one-size-fits- all" approach to PCMH implementation. This justifies the core focus on gaining knowledge around PCP and nurse experiences implementing gold-standard PCMH principles for an important patient subgroup. Much of the extant research in this area has not yet examined the model's implementation experiences with specific patient subpopulations such as older adults. Thus, the project fills a needed empirical gap by identifying PCMH implementation best practices that are aligned closely with the unique needs and characteristics of older adult populations accessing primary care services. In addition, the study approach is novel because it applies a social psychological, agency-based perspective on the question of how to think about medical home implementation and measurement. This would be one of the first known research studies to examine PCMH implementation and measurement from the perspective of the everyday social interactions and exchanges occurring between primary care providers and their older adult patients. Its sociological orientation complements the economic and structural perspectives that researchers studying the PCMH have largely used, in this way adding new knowledge to our understanding of PCMH implementation. From an applied perspective, the rich description produced through interview data and the resulting implementation best practices that get identified will be disseminated to other organizations engaging in PCMH care. These organizations can then take this knowledge and use it to improve their own PCMH implementation processes.