Health Care Transformation Among Small Urban Practices Serving the Underserved

描述（由申请人提供）：卫生保健战略中心（CHCS）、纽约大学（NYU）罗伯特·f·瓦格纳公共服务研究生院（Robert F. Wagner Graduate School For Public Service）和纽约市卫生和心理卫生部（NYCDOHMH）的初级保健信息项目（PCIP）之间拟议的合作将利用PCIP正在进行的努力来改变纽约市的初级保健实践和描述这些实践的大量可用数据。拟议的研究将侧重于一组不同的小型城市实践（少于5家供应商），这些实践拥有大量的医疗补助和/或未投保的患者，这些患者在PCIP的支持下参与了至少一年的多次转型过程。本研究的主要目标是：1)利用大量（N=105+）经历转型过程至少一年的小型城市初级保健实践的二手数据，了解管理/转型过程的变化、卫生保健过程的现状和变化、患者结局的现状和变化以及这些变量之间的相互关系；2)采用混合方法，包括提供者调查和对患者的关键信息提供者访谈，评估实践转化活动对卫生保健提供者及其患者的影响；3)使用详细的实践评估、现场访问和关键信息提供者访谈来深入检查转换组件的实施，并关注影响40个选定实践的实施和成功的组织和上下文因素；4)通过在专业组织和医学协会的会议和会议上的演讲、基于网络的最佳实践“工具包”和同行评议的期刊文章，广泛传播本研究的发现。

DESCRIPTION (provided by applicant): The proposed collaboration among the Center For Health Care Strategies (CHCS), The Robert F. Wagner Graduate School for Public Service of New York University (NYU) and the Primary Care Information Project (PCIP) of the New York City Department of Health and Mental Hygiene (NYCDOHMH) will capitalize on the ongoing efforts of PCIP to transform primary care practices in New York City and the extensive amount of available data describing these practices. The proposed study will focus on a diverse set of small urban practices (< 5 providers) with high volumes of Medicaid and/or uninsured patients that have been engaged in multiple transformation processes under the auspices of the PCIP for at least one year. The main goals of the study are to: 1) Utilize secondary data for a large number (N=105+) of small, urban primary care practices that have undergone transformation processes for at least one year to understand changes in management/transformation processes, status and changes in health care processes, and status and changes in patient outcomes and the interrelationships among these variables; 2) Utilize mixed methods, including a provider survey and key informant interviews with patients, to assess the effects of practice transformation activities on health care providers and their patients; 3) Use a detailed practice assessment, site visits, and key informant interviews to examine in depth the implementation of transformation components with attention to the organizational and contextual factors that affected implementation and success in 40 selected practices; and 4) Disseminate the findings from this study widely via presentations at conferences and meetings of professional organizations and medical societies, a web based "tool kit" of best practices, and peer-reviewed journal articles. PUBLIC HEALTH RELEVANCE: The proposed study will inform primary care providers, payers, health services researchers, and policy-makers about methods to achieve primary care practice transformation in small practices with high volumes of Medicaid and uninsured patients. In a time of increasing resource constraints, rising medical need, and a projected shortage of primary care providers, such information will be critical to ensuring patient-centered primary medical care for all patients in the US, particularly the most vulnerable.