A climate for evidence-based practice implementation in the patient-centered medical home

 描述(申请人提供)：美国医疗体系被认定为16个工业国中死亡率最差的国家，3在可获得性和安全性方面排名较差，以病人为中心的医疗之家被认为是美国改善健康的一种提供制度创新，22也是当前医疗改革努力的基石。4-7改革努力的成功将主要通过三重目标框架的三个领域来衡量：1)改善患者的护理体验，2)改善人口健康，同时降低医疗成本。38以患者为中心的医疗之家能否成功实现三重目标，取决于能否提供有效的治疗和干预措施(即循证实践)。在PCMH中有效使用EBPS取决于组织内的支持性气氛。14-15然而，PCMH中的组织气氛在多大程度上支持或阻碍EBPS尚不清楚。这项混合方法研究将评估EBP的实施环境(即，组织成员在多大程度上认为采用EBP是被期望、支持和回报的)，以及PCMH对EBP的态度。这项研究将在两个实践中做到这一点，一个是已经获得NCQA 3级认证的PCMH(PCMH)，另一个是计划转变为PCMH(非PCMH)。此外，这项研究将评估在这两个实践中，EBP实施环境和对EBPS的态度随着时间的推移可能发生的变化。随着时间的推移，了解在PCMH和非PCMH实践中实施EBP的环境将有助于为制定促进EBPS的战略提供信息，进一步有助于加快PCMH向实现三重目标的转变。拟议的研究研究非常符合AHRQ的使命和研究优先领域#1：通过加快实施以患者为中心的结果研究(PCOR)来提高医疗质量。具体地说，这项提案的结果将指导旨在通过加快在初级保健和保健中心可持续实施循证保健计划来提高健康和保健质量的干预措施的开发和利用。

 DESCRIPTION (provided by applicant): The United States healthcare system is identified as being the worst of sixteen industrial nations with regard to amenable mortality,3 ranks poorly on access and safety,4 and rewards quantity of services delivered at the expense of higher quality care.2 The patient-centered medical home (PCMH) is considered a delivery system innovation for improving health in the United States22 and is a cornerstone of current health care reform efforts.4-7 The success of reform efforts will be measured primarily across the three domains of the Triple Aim framework: simultaneously 1) enhancing patient experiences of care and 2) improving population health while 3) reducing health care costs.38 The success of the PCMH to achieve the Triple Aim is dependent on the delivery of treatments and interventions with demonstrated effectiveness (i.e., evidence-based practice (EBPs)). Effective use of EBPs in the PCMH is contingent on a supportive climate in the organization.14-15 However, the extent to which the organizational climate in the PCMH supports or impedes EBPs is unknown. This mixed- methods study will assess EBP implementation climate (i.e., the extent to which organizational members perceive that the adoption of EBPs is expected, supported, and rewarded) and attitudes about EBPs in the PCMH. This study will do so in two practices, one that has achieved recognition as an NCQA Level 3 certified PCMH (PCMH), and another that plans to transform into a PCMH (non- PCMH). Additionally, this study will assess potential changes in EBP implementation climate and attitudes about EBPs over time within these two practices. Understanding the climate for EBP implementation in the PCMH and non-PCMH practices over time will help in informing the development of strategies to promote EBPs, further serving to accelerate PCMH transformation toward achieving the Triple Aim. The proposed research study is an excellent fit with the AHRQ's Mission and Research Priority Area #1: Improve health care quality by accelerating implementation of patient centered outcomes research (PCOR). Specifically, results from this proposal will guide the development and utilization of interventions designed to improve health and healthcare quality by accelerating the sustainable implementation of EBPs in the PCMH.