Examining the Costs of a Medical Home Transformation for Seniors

量化老年人医疗之家改造的成本 摘要： 拟议项目旨在提供有关实施以患者为中心的医疗服务的成本的证据。 家庭（PCMH）的组成部分，通过比较老年患者的健康护理重新设计的成本， HealthCare Partners Medical Group（HCP）是一家综合医疗集团，拥有31个执业场所， HCP的独立执业协会（IPA）网络的执业场所，共计244个初级保健 在大洛杉矶地区的练习场地。以前的研究强调， 医疗组接受更高质量的护理，并报告更好的护理经验相比， IPA医师（1、2）。没有研究，审查了管理 在这些组织模式中为临床复杂的老年患者提供预防性护理。转化 对于临床医生和小型诊所的工作人员来说，小型初级保健诊所很难进入PCMH 由于有限的质量改进（QI）基础设施和实践重新设计经验， IPA设置（3）。因此，投资促进机构的启动费用和增量费用可能会更高， 由于提供更多的场外服务，协调成本很高。我们假设启动成本 平均而言，与老年保健重新设计相关的增量费用将较低， 与IPA初级保健实践相比，综合医疗组的初级保健实践地点 网站. HCP是一个责任关怀组织（ACO），处于测试创新的最前沿， 为不同的患者群体提供慢性病护理。进一步检查PCMH的“真实的世界”成本影响 实施，加州大学洛杉矶分校，HCP医疗集团，和HCP应用研究和教育研究所 建议合伙人：1.为老年人健康护理重新设计开发成本捕获模板（CCT），使用 “健康处方”（P4 H）成本估算框架，2。反向量化启动， 与HCP中的高级健康护理重新设计相对应的增量和员工实践费用 综合初级保健实践（PCP），3。比较研究中心的启动费用、增量费用和员工费用- 在HCP和IPA的PCP之间实施PCMH重新设计，并进行敏感性分析。 PCMH旨在促进患者和医疗保健提供者之间的长期关系， 管理持续的健康状况，提高治疗依从性。培养病人的相对成本- 然而，还没有探索用于老年患者的集中式健康护理。据我们所知，没有研究 同时估算了PCMH转型的启动和增量实践费用， 比较了综合医疗团体和投资促进机构的初级保健做法的这些成本。拟议 比较成本分析将在18个月内完成。结果将有利于政策领导人和公众 和私人医疗保健组织时，为实施PCMH组件提供资源并激励 改变做法，以改善在不同的PCP环境中对患有多种慢性病的老年人的护理。

Quantifying Costs of a Medical Home Transformation for Seniors ABSTRACT: The proposed project aims to generate evidence about the costs of implementing Patient Centered Medical Home (PCMH) components by comparing costs of a wellness care redesign for older adult patients of HealthCare Partners Medical Group (HCP), an integrated medical group with 31 practice sites, and 213 practices sites of HCP's network of Independent Practice Associations (IPAs), totaling 244 primary care practice sites in the greater Los Angeles area. Previous research has underscored that patients of integrated medical groups receive higher quality of care and report better experiences of care compared to patients of IPA physicians (1, 2). No research, has examined the resource requirements and costs for managing the preventive care of clinically complex older adult patients across these organizational models. Transforming small primary care practices into PCMHs has been very difficult for clinicians and staff of small practices because of the limited quality improvement (QI) infrastructure and practice redesign experiences available in IPA settings (3). Consequently, start-up and incremental expenses are likely to be higher in IPA practices with extensive coordination costs due to providing more services off-site. We hypothesize that the start-up costs and incremental expenses associated with senior wellness care redesign will be lower, on average, for primary care practice sites in the integrated medical group compared to the IPA primary care practice sites. HCP is an Accountable Care Organization (ACO) at the forefront of testing innovations for delivering chronic illness care to diverse patient populations. To further examine "real world" cost impacts of PCMH implementation, UCLA, HCP Medical Group, and the HCP Institute for Applied Research and Education propose to partner to: 1. Develop a cost capture template (CCT) for the senior wellness care redesign using the "Prescription for Health" (P4H) framework of cost estimation, 2. Retrospectively quantify start-up, incremental and staff practice expenses corresponding to the senior wellness care redesign in HCP's integrated primary care practices (PCPs), 3. Compare the start-up, incremental and staff expenses for site- level implementation of the PCMH redesign between HCP's and IPAs' PCPs and perform sensitivity analyses. PCMHs aim to foster long-term relationships between patients and healthcare providers to more effectively manage ongoing health conditions and improving treatment adherence. The relative costs of fostering patient- centered wellness care for older adult patients, however, have not been explored. To our knowledge, no study has simultaneously estimated start-up and incremental practice expenses for PCMH transformation and compared these costs in primary care practices of integrated medical groups and IPAs. The proposed comparative cost analyses will be completed in 18 months. The results will benefit policy leaders and public and private healthcare organizations when resourcing implementation of PCMH components and incentivizing practice changes to improve care for older adults with multiple chronic conditions in diverse PCP settings.