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）。它采用定性的方法来探索PCP和老年人PCMH护理的护士经验，并确定由这些经验产生的提供者信念、知识和学习。然后，研究将经验、信念、知识和学习与特定的策略、方法和活动联系起来，当提供者试图更有效地向老年患者提供一种或多种PCMH护理原则时，他们会参与这些策略、方法和活动。这些“实施最佳做法”将按具体的PCMH原则进行分类，并可在进行家庭医疗护理的初级保健工作环境中得到验证和进一步应用。该项目的访谈对象为60名执业医师和护士。此外，将举行两个焦点小组的pcp和护士，以帮助验证和完善访谈结果。这项探索性研究的最终成果有两个方面：(a)丰富的日常经验描述，知识收获，以及为老年人提供PCMH护理的一组pcp和护士的学习积累，以及(b)实施最佳实践的类别（策略，方法和活动），可能会改善老年人的PCMH护理服务。这项研究在几个方面都具有创新性。首先，它是由一种普遍的观念所驱动的，即没有一种“放之四海而皆准”的PCMH实施方法。这证明了核心重点是获得关于PCP的知识和护士经验，为一个重要的患者亚组实施黄金标准的PCMH原则。该领域的许多现有研究尚未检验该模型在特定患者亚群（如老年人）中的实施经验。因此，该项目通过确定与获得初级保健服务的老年人口的独特需求和特点密切相关的PCMH实施最佳做法，填补了必要的经验空白。此外，研究方法是新颖的，因为它应用了社会心理学，基于机构的观点对如何思考医疗家庭实施和测量的问题。这将是已知的第一个从初级保健提供者和老年患者之间发生的日常社会互动和交流的角度来检查PCMH实施和测量的研究之一。它的社会学取向补充了研究PCMH的研究人员大量使用的经济和结构观点，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和最终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实施流程。

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.