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)模式的发展是为了满足对初级保健提供系统的迫切需求，该系统能够产生更好的护理协调，改善健康结果，并能够控制资源使用和成本。实施医疗之家通常需要进行全方位的重新设计，以促进1)医疗服务的可获得性、连续性、全面性和协调性；2)慢性护理模式；3)先进的信息技术；以及4)促进更好地获得患者机会和结果的报销激励。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，在我们对单个医疗诊所或诊所组在PCMH模式实施的实施和维护阶段产生的直接和间接真实成本的理解方面，仍然存在显著的知识差距。自2006年以来，总部位于俄勒冈州波特兰的非营利性医疗补助管理保健计划CareOregon一直与为其成员提供初级保健的选定诊所合作，以实施一项名为初级保健更新(PCR)的医疗之家计划。合作伙伴关系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。参与实践同意建立基于团队和客户驱动的护理、无障碍访问、主动小组健康改善以及现场或以其他方式集成的行为健康服务。自那以后，CareOregon通过组织以患者和人群为中心的初级保健(PC3)课程来扩展其PCR工作，该课程本质上是一个培训计划，允许对PCMH实施感兴趣的诊所探索PCR经验。俄勒冈州西部的各种医疗系统现在都参与了PC3协作式学习。本研究以过程改进理论为框架，运用成本计算法和定性研究方法，对PCMH实践成功转型的直接成本和间接成本进行识别、分类和量化。这些信息将对在PC3协作中心和其他地方探索PCMH转型的诊所非常有用。我们将把结构性信息与预算和其他财务数据结合起来，为PCMH转型开发基于作业的成本模型。我们将在选定的PC3诊所与主要线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.