Impact of a Team-based Approach to Primary Care: A Natural Experiment in Primary Care Redesign

基于团队的初级保健方法的影响：初级保健重新设计的自然实验

• 批准号: 9980341
• 负责人: Anita Diana Misra-Hebert
• 金额: $ 14.54万
• 依托单位: CLEVELAND CLINIC FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980341
• 关键词: Impact; Team; based; Approach; Primary

 DESCRIPTION (provided by applicant): The purpose of this K08 AHRQ Patient-Centered Outcomes Research (PCOR) Mentored Clinical Investigator Award is to establish Dr. Anita Misra-Hebert as an independent investigator studying natural experiments in redesigning primary care delivery systems. Her goal is to develop high-level skills in implementation science quantitative and qualitative research methods, with an emphasis on defining contextual factors that may promote success or failure of specific primary care redesign efforts in diverse practice settings. Dr. Misra-Hebert will gain practical expertise in PCOR primary care redesign through both formal and informal educational programs and through close work with her mentors during this project. Dr. Kurt Stange, her primary research mentor, is a recognized expert in the study of contextual factors in primary care practice redesign. Her co-mentors include Dr. David Aron, a recognized expert in implementation science research methods, Dr. Michael Rothberg, an expert in quantitative research methods, specifically related to observational studies with large datasets, and Dr. Adam Perzynski, a sociologist and an expert in qualitative and quantitative research methods. Environment Located in Cleveland, Ohio, Cleveland Clinic is a nonprofit, multispecialty academic medical center that integrates clinical and hospital care with research and education, and one of the largest and most respected hospitals in the country. Cleveland Clinic is structured as a group practice. The physicians on staff are salaried employees and are not in private practice. The practice is structured to complement the group practice model. The Medicine Institute at Cleveland Clinic is leading efforts across the institution to promote value-based care initiatives for patient care. The Medicine Institute Center for Value-Based Care Research specializes in health services and clinical research regarding novel approaches to care that can improve quality, reduce cost, or both. The Center includes 4 primary investigators, nurses, statisticians and research assistants, as well as affiliated health services researchers from across the Cleveland Clinic. Dr. Misra-Hebert will be fully supported in this environment to conduct research to evaluate best practices in primary care redesign efforts. The ability of the Cleveland Clinic and its Medicine Institute to support Dr. Misra-Hebert's research and development is greatly enhanced by the Cleveland Clinical & Translational Science Collaborative, which provides collaborative clinical research support and infrastructure across the institutions represented on her mentoring team. Research Project This goal of this study is to provide evidence of best practices for the delivery of team-based primary care with evaluation of contextual factors in the implementation of primary care redesign efforts. As the complexity of healthcare delivery increases, primary care is moving from a model of care delivery in which individual clinicians provide care to individual patients to team-based care models. To understand whether these new models have actually improved value in care delivery, it will be important to measure outcomes relevant to patients and those specific to team-based care. Team approaches will need to be optimized based on diverse contextual factors. The initial project will focus on the evaluation of contextual factors relevant to a specific team-based redesign effort involving an enhanced role of medical assistants compared to usual care and will include evaluation of patient and provider experience. The specific aims of the proposed research are as follows: Aim 1: To evaluate patient-centered clinical quality of care outcomes in the team-based care-medical assistant model (TBC-MA) compared to usual care. Aim 2: To identify contextual factors (patient, provider, practice) that contribute to the sustained implementation of the TBC-MA model. Aim 3: To assess patient and provider experience in the TBC-MA model compared to usual care. Later work during the career development award will include study of the longitudinal effects of team-based care, and redesign implementation that involves non-clinician care team members in improving care coordination for primary care patients.

 描述(申请人提供)：本次K08 AHRQ以患者为中心的结果研究(PCOR)指导临床研究员奖的目的是将Anita Misra-Hebert博士确立为一名独立研究员，研究重新设计初级保健提供系统的自然实验。她的目标是发展实施科学定量和定性研究方法的高级技能，重点是确定可能在不同实践环境中促进特定初级保健重新设计努力成败的背景因素。Misra-Hebert博士将通过正式和非正式的教育项目以及在该项目期间与她的导师的密切合作，获得PCOR初级保健重新设计方面的实用专业知识。库尔特·斯坦奇博士，她的主要研究导师，是初级保健实践重新设计中背景因素研究的公认专家。她的共同导师包括执行科学研究方法方面的公认专家David Aron博士，定量研究方法专家Michael Rothberg博士，特别是与大型数据集的观察性研究相关的专家Michael Rothberg博士，以及社会学家兼定性和定量研究方法专家Adam Perzynski博士。环境中心位于俄亥俄州克利夫兰，克利夫兰诊所是一家非营利性、多专科的学术医疗中心，集临床和医院护理与研究和教育于一体，是美国最大和最受尊敬的医院之一。克利夫兰诊所的组织形式是集体实践。员工中的医生是受薪员工，不是私人执业。练习的结构是对小组练习模式的补充。克利夫兰诊所的医学研究所正在领导整个机构的努力，以促进病人护理的基于价值的护理倡议。医学研究所基于价值的护理研究中心专门从事关于可以提高质量、降低成本或两者兼而有之的新型护理方法的卫生服务和临床研究。该中心包括来自克利夫兰诊所的4名主要调查人员、护士、统计学家和研究助理，以及附属的卫生服务研究人员。在这种环境下，Misra-Hebert博士将得到全力支持，以进行研究，以评估初级保健重新设计工作中的最佳做法。克利夫兰临床与转化科学合作项目极大地增强了克利夫兰诊所及其医学研究所支持Misra-Hebert博士研发的能力，该项目为她的指导团队所代表的机构提供协作性临床研究支持和基础设施。研究项目这项研究的目标是通过评估实施初级保健重新设计工作的背景因素，为提供以团队为基础的初级保健提供最佳做法的证据。随着医疗保健提供的复杂性增加，初级保健正在从由个别临床医生为个别患者提供护理的提供模式转变为基于团队的护理模式。为了了解这些新模式是否确实提高了护理交付的价值，重要的是要衡量与患者相关的结果以及那些特定于基于团队的护理的结果。团队方法将需要根据不同的背景因素进行优化。最初的项目将侧重于评估与具体的基于团队的重新设计工作有关的背景因素，包括与常规护理相比，医疗助理的作用得到加强，并将包括对患者和提供者体验的评估。本研究的具体目的如下：目的1：评估以病人为中心的团队护理-医疗助理模式(TBC-MA)与常规护理的临床护理质量结果。目标2：确定有助于TBC-MA模式持续实施的背景因素(患者、提供者、实践)。目标3：评估TBC-MA模式中的患者和提供者的体验，并将其与常规护理进行比较。职业发展奖的后续工作将包括研究以团队为基础的护理的纵向影响，以及重新设计实施方案，让非临床医生护理团队成员参与改善初级保健患者的护理协调。

项目成果

Effect of Health Plan Financial Incentive Offering on Employees with Prediabetes.

健康计划财务激励措施对糖尿病前期员工的影响。

• DOI: 10.1016/j.amjmed.2017.09.024
• 发表时间: 2018
• 期刊: The American journal of medicine
• 作者: Misra-Hebert,AnitaD;Hu,Bo;Le,PhucH;Rothberg,MichaelB
• 通讯作者: Rothberg,MichaelB

Comment on: Decisional Conflict, Regret, and the Burden of Rational Decision Making.

评论：决策冲突、遗憾和理性决策的负担。

• DOI: 10.1177/0272989x17691759
• 发表时间: 2017
• 期刊: Medical decision making : an international journal of the Society for Medical Decision Making
• 作者: Misra-Hebert,AnitaD;Kattan,MichaelW
• 通讯作者: Kattan,MichaelW

Natural Language Processing Improves Detection of Nonsevere Hypoglycemia in Medical Records Versus Coding Alone in Patients With Type 2 Diabetes but Does Not Improve Prediction of Severe Hypoglycemia Events: An Analysis Using the Electronic Medical Record

与 2 型糖尿病患者单独编码相比，自然语言处理可以改善病历中非严重低血糖的检测，但不能改善严重低血糖事件的预测：使用电子病历进行分析

• DOI: 10.2337/dc19-1791
• 发表时间: 2020
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: Misra-Hebert,AnitaD;Milinovich,Alex;Zajichek,Alex;Ji,Xinge;Hobbs,ToddD;Weng,Wayne;Petraro,Paul;Kong,SheldonX;Mocarski,Michelle;Ganguly,Rahul;Bauman,JanineM;Pantalone,KevinM;Zimmerman,RobertS;Kattan,MichaelW
• 通讯作者: Kattan,MichaelW

Cervical cancer in African American women: Optimizing prevention to reduce disparities.

非裔美国妇女的宫颈癌：优化预防以减少差异。

• DOI: 10.3949/ccjm.84a.17041
• 发表时间: 2017
• 期刊: Cleveland Clinic journal of medicine
• 影响因子: 6.1
• 作者: Misra-Hebert,AnitaD

Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.

实施基于团队的初级保健模式：大型综合医疗保健系统中的混合方法比较案例研究。

• DOI: 10.1007/s11606-018-4611-7
• 发表时间: 2018
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Misra-Hebert,AnitaD;Perzynski,Adam;Rothberg,MichaelB;Fox,Jaqueline;Mercer,MaryBeth;Liu,Xiaobo;Hu,Bo;Aron,DavidC;Stange,KurtC
• 通讯作者: Stange,KurtC