Estimating the Costs of Primary Care Renewal

描述（由申请人提供）：以患者为中心的医疗之家（PCMH）模式的发展是为了解决对初级保健提供系统的迫切需求，这些系统可以产生更好的护理协调，改善健康结果，并可以控制资源使用和成本。实施医疗之家通常需要对整个实践进行重新设计，以促进1）获得，连续性，全面性和护理协调; 2）慢性病护理模式; 3）复杂的信息技术; 4）促进更好的患者获得和结果的报销激励。许多医疗保健系统热情地接受了PCMH模式，早期评估表明取得了可衡量的成功。然而，在我们对PCMH模型实施的实施和维护阶段期间，单个医疗保健诊所或诊所组所产生的直接和间接真实成本的理解方面，仍然存在重大的知识差距。自2006年以来，俄勒冈州波特兰的非营利医疗补助管理医疗计划CareOregon一直与为其成员提供初级保健的精选做法合作，实施一项名为初级保健更新（PCR）的医疗家庭计划。PCR提供报销和其他支持，以鼓励提供多学科，协调和全面护理的做法。参与的实践同意建立以团队为基础和以客户为导向的护理、无障碍通道、积极主动的小组健康改善以及现场或其他综合行为健康服务。CareOregon已经通过组织以患者和人口为中心的初级保健（PC 3）课程来扩展其PCR工作，该课程基本上是一个培训计划，允许对PCMH实施感兴趣的诊所探索PCR经验。整个俄勒冈州西部的各种医疗系统现在都参与了PC 3学习协作。本研究以过程改进理论为框架，运用成本计算方法和定性研究方法，对成功的PCMH实践转型的直接和间接成本进行识别、分类和量化。这些信息对于在PC 3协作和其他地方探索PCMH转型的诊所非常有用。我们将联合收割机结构信息与预算和其他财务数据相结合，为PCMH转型开发一个基于作业的成本模型。我们将与选定的PC 3诊所的关键知情人一起审查我们的模型和结果。

DESCRIPTION (provided by applicant): The patient-centered medical home (PCMH) model evolved to address the urgent need for primary care delivery systems that could produce better care coordination, improve health outcomes, and could control resource use and costs. Implementing a medical home usually requires a whole-practice redesign that promotes 1) access to, continuity, comprehensiveness, and coordination of care; 2) the chronic-care model; 3) sophisticated information technology; and 4) reimbursement incentives that facilitate better patient access and outcomes. Many healthcare systems have embraced the PCMH model enthusiastically, and early evaluations suggest measurable successes. However, significant knowledge gaps still remain in our understanding of the true costs, both direct and indirect, that an individual healthcare clinic or group of clinics incurs during the implementation and maintenance phases of a PCMH-model implementation. Since 2006, CareOregon, a Portland, Oregon-based nonprofit Medicaid managed-care plan, has worked with select practices that provide primary care to its members to implement a medical-home program called Primary Care Renewal (PCR). PCR provides reimbursement and other support to encourage practices to provide multidisciplinary, coordinated, and comprehensive care. Participating practices agreed to establish team- based and customer-driven care, barrier-free access, proactive panel health improvement, and onsite or otherwise integrated behavioral health services. CareOregon has since extended its PCR work by organizing the Patient and Population Centered Primary Care (PC3) curriculum, which is essentially a training program to allow clinics interested in PCMH implementation to explore the PCR experience. Various medical systems throughout western Oregon now participate in the PC3 learning collaborative. Our study uses process- improvement theory as a framework to apply costing methodology and qualitative research methods to the identification, categorization, and quantification of the direct and indirect costs of successful PCMH practice transformation. This information will be extremely useful for clinics exploring PCMH transformation, at the PC3 collaborative and elsewhere. We will combine structural information with budget and other financial data to develop an activity-based cost model for PCMH transformation. We will review our model and results with key informants at selected PC3 clinics.