Implementation and Impact of VA Patient-Centered Medical Home

VA 以患者为中心的医疗之家的实施和影响

• 批准号: 8181730
• 负责人: ELIZABETH M YANO
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2012-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8181730
• 关键词: Address; Adopted; Adoption; Area; Beryllium; Caring; Characteristics; Chronic Disease; Data; Data Quality; Elements; Environment; Future; Glycosylated hemoglobin A; Health Care Reform; Healthcare; Home environment; Indium; Institutes; Left; Link; Los Angeles; Measures; Medical; Medical Societies; Mental Health; Methods; Modeling; National Committee for Quality Assurance; Outcome; Patient Care; Patients; Performance; Policies; Policy Maker; Population; Preventive; Primary Health Care; Process; Provider; Quality of Care; Recommendation; Reporting; Resources; Retinal; Rewards; Services; Site; Strategic Planning; Stress; Surveys; United States Health Resources and Services Administration; Update; Work; base; care delivery; career; caregiving; clinical practice; design; diabetic; evidence base; flu; medical specialties; meetings; patient oriented; payment; primary outcome; response

PROJECT BACKGROUND/RATIONALE: Primary care delivery is at a crossroads. Pundits point to a "perfect storm" and the impending "collapse of primary care" given how few medical trainees are moving into primary care, while others are leaving practice thanks to dwindling reimbursements, leaving the future of primary care uncertain. Patient-centered medical homes (PCMH) represent an updated primary care model that recognizes and rewards, through appropriate payment, the diverse but necessary activities of a primary care home base for a population of patients.4,5 Most major medical societies, and many public and private health care funders currently endorse some version of this concept. While extensive evidence documents the relationships between primary care and outcomes, there is remarkably little information on relationships between specific PCMH features and outcomes. In addition, there is almost no information on characteristics of sites that promote adoption of PCMH features. This proposal aims to use data from a 2007 all-VA survey of over 200 VA primary care practices to assess links between PCMH features and quality of care in VA, and understand which types of VA practices are most likely to adopt PCMH features. PROJECT OBJECTIVES: We propose to: Aim #1: Evaluate the impacts of existing VA patient-centered medical home models on quality of care, including which elements are most effective; Aim #2: Determine the factors related to successful site adoption of patient-centered medical home models and features in VA; Aim #3: Use expert panel methods to integrate and apply findings from Aims #1 and #2 to develop practice and policy recommendations on evidence-based primary care delivery models. PROJECT METHODS: For Aim #1, we will merge data from the VA Clinical Practice Organizational Survey (CPOS) on PCMH features with existing VA quality data on preventive practice (e.g., flu shots), chronic disease processes (e.g., diabetic retinal exams) and intermediate outcomes (e.g., HbA1c), and patient ratings of care (e.g., access, continuity, coordination). We will use multi-level models to examine contributions of PCMH features to quality, adjusting for patient-level covariates. For Aim #2, we will analyze practice environment measures (from CPOS and administrative data) and area characteristics chiefly from the Area Resource File linked to CPOS practice data. For Aim #3, we will use expert panel methods to engage VA and non-VA national leaders in primary care and PCMH to develop practice/policy recommendations based on evidence generated from Aims #1 and #2.

项目背景/依据：初级保健服务正处于十字路口。权威人士 指出一场“完美风暴”和即将到来的“初级保健崩溃”， 受训者正在进入初级保健，而其他人则由于日益减少的 这意味着，医疗保健的未来不确定。以病人为中心的医疗之家 （PCMH）代表了一种更新的初级保健模式，通过 适当的支付，初级保健家庭基地的多样化但必要的活动， 4，5大多数主要的医学协会，以及许多公共和私人医疗保健 资助者目前赞同这一概念的某些版本。虽然大量的证据文件 初级保健和结果之间的关系，有非常少的信息， 具体PCMH特征和结果之间的关系。此外，几乎没有 有关促进采用PCMH功能的网站特征的信息。这项建议 旨在使用2007年对200多个VA初级保健实践进行的全VA调查的数据来评估 PCMH特征与VA护理质量之间的联系，并了解哪些类型的VA 实践最有可能采用PCMH功能。 项目目标：我们建议：目标1：评估现有VA的影响 以病人为中心的医疗家庭模式对护理质量，包括哪些元素是最重要的 有效;目标2：确定与以患者为中心的临床试验机构成功采用相关的因素 VA中的医疗家庭模型和功能;目标#3：使用专家小组方法来整合和 应用目标1和目标2的调查结果，制定关于以下方面的做法和政策建议： 以证据为基础的初级保健提供模式。 项目方法：对于目标1，我们将合并来自VA临床实践的数据 关于PCMH特征的组织调查（CPOS），以及预防性VA的现有质量数据 实践（例如，流感疫苗），慢性疾病过程（例如，糖尿病视网膜检查）和 中间结果（例如，HbA 1c）和患者护理评级（例如，访问，连续性， 协调）。我们将使用多层次模型来研究PCMH特征对 质量，调整患者水平协变量。对于目标#2，我们将分析实践环境 测量（来自CPOS和行政数据）和主要来自“区域”的区域特征 链接到CPOS实践数据的资源文件。对于目标#3，我们将使用专家小组方法， 让VA和非VA国家领导人参与初级保健和PCMH，以制定实践/政策 根据目标#1和#2产生的证据提出建议。