Estimating Costs Associated with PCMH Transformation

总结/摘要 美国的初级保健质量不理想。研究人员、政策制定者和 多年来，从业人员提出了一些干预措施，以解决人们认为和认识到的 初级保健实践中的问题。以病人为中心的医疗之家（PCMH） 是一个最近的和有前途的方法来改善初级保健。尽管迄今为止的证据表明 PCMH模型的有效性好坏参半，一些研究表明， 将实践转化为PMCH将导致质量的提高，成本的降低， 以患者为中心和提供者满意度的改善。 然而，成功的PCMH转型可能需要大量的财政投资。当 财政投入不足，实践可能无法实现成功转型， 因此，不符合PCMH模型的目标。对金融投资知之甚少 以确保成功转型。由于这些财务估计不存在，付款人， 决策者和实践领导者永远无法确保他们的投资足以实现 成功转型。为了解决这一重要问题，我们将采用混合方法， 多个案例研究设计的基础上半结构化访谈的做法代表，财务 记录和成本调查，以量化PCMH的一次性/持续和直接/间接成本 转型我们的估计将是通知支付者和政策制定者的第一步，也是重要的一步。 最佳投资水平。

SUMMARY/ABSTRACT The quality of primary care in the United States is suboptimal. Researchers, policymakers, and practitioners have proposed a number of interventions over the years to address perceived and realized problems within primary care practices. The development of patient centered medical homes (PCMH) is a recent and promising approach to improving primary care. Although the evidence to date on the effectiveness of the PCMH model has been mixed, some studies have suggested that successful transformation of practices into PMCHs will lead to improvements in quality, reductions in costs, and improvements in both patient-centeredness and provider satisfaction. However, successful PCMH transformation will likely require substantial financial investment. When the financial investment is insufficient, practices may not achieve successful transformation and, therefore, not meet the goals of the PCMH model. Little is known about the financial investment necessary to ensure successful transformation. Because these financial estimates do not exist, payers, policymakers, and practice leaders can never be sure that their investments are sufficient to achieve successful transformation. In order to address this important issue, we will employ mixed method, multiple case study design based on semi-structured interviews with practice representatives, financial records, and cost surveys in order to quantify the one-time/ongoing and direct/indirect costs of PCMH transformation. Our estimates will be a first and important step to informing payers and policymakers regarding the optimal level of investment.