Health Care Transformation Among Small Urban Practices Serving the Underserved

描述(由申请人提供)：卫生保健策略中心(CHCs)、纽约大学(NYU)罗伯特·F·瓦格纳公共服务研究生院(NYU)和纽约市卫生与精神卫生部门初级保健信息项目(PCIP)之间拟议的合作将利用PCIP为改变纽约市初级保健实践所做的持续努力以及描述这些做法的大量现有数据。拟议的研究将侧重于一组不同的小城市实践(&lt；5提供者)，他们拥有大量的医疗补助和/或未参保的患者，他们在PCIP的主持下参与了多个转型过程至少一年。这项研究的主要目标是：1)利用大量(N=105)经历了至少一年转型过程的小型城市初级保健实践的二次数据，以了解管理/转型过程的变化、卫生保健过程的状况和变化、患者结果的现状和变化以及这些变量之间的相互关系；2)利用混合方法，包括提供者调查和对患者的关键信息访谈，来评估实践转型活动对卫生保健提供者及其患者的影响；3)利用详细的做法评估、现场访问和关键信息提供人访谈，深入审查转型组成部分的实施情况，同时注意影响40个选定做法的实施和成功的组织和背景因素；以及4)通过在专业组织和医学会的会议和会议上的陈述、基于网络的最佳做法“工具包”和同行评议的期刊文章，广泛传播本研究的结论。 公共卫生相关性：拟议的研究将告知初级保健提供者、支付者、卫生服务研究人员和政策制定者如何在拥有大量医疗补助和未参保患者的小型实践中实现初级保健实践转变。在资源日益紧张、医疗需求不断上升以及初级保健提供者预计短缺的情况下，这些信息对于确保美国所有患者，特别是最脆弱的患者获得以患者为中心的初级医疗保健至关重要。

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.