Restoring Primary Care in Virginia: PCOR Learning as a Pathway to Value

 描述(由申请人提供)：在弗吉尼亚州恢复初级保健：PCOR学习作为实现价值的途径是弗吉尼亚州卫生创新中心(VCHI)在其弗吉尼亚州卫生创新计划中解决初级保健转型的工作的延伸。VCHI将与弗吉尼亚州的四所医学院、弗吉尼亚州健康质量中心(VHQC)和乔治梅森大学的评估专家合作，组成弗吉尼亚州初级保健转型合作(VPCTC)。他们将使用循证的综合战略帮助多达300家中小型初级保健实践：1)加快将PCOR临床和组织研究结果应用于实践，最初的重点是心血管健康和ABC；2)提高他们持续整合PCOR新发现的能力；以及3)学习能够帮助他们维持和振兴其组织，同时使喜悦恢复初级保健实践的战略。实践支持将包括现场指导、专家咨询、协作学习活动、在线支持中心以及数据反馈和基准确定。作为这个名为“在弗吉尼亚州恢复初级保健”的项目的结果，参与实践将发展更强的QI能力和学习策略，以帮助他们维持和振兴他们的组织，同时恢复喜悦的初级保健实践。招募和保留参与实践的价值主张包括：改善财务业绩；提高临床医生、工作人员和患者的满意度；客观上提高护理质量；提高谈判和获得绩效奖金(包括EMR有意义的使用阶段2)的能力；完成ABFM和ABIM对本计划中完成的QI工作的第四部分认证；以及在项目结束后参与自我维持的学习协作和类似实践。评估计划旨在 回答这些问题：(1)VPCTC干预是否改善了弗吉尼亚州小医生执业的绩效？(2)干预的哪些要素对医生的绩效改进最重要？(3)“维护”或后续干预活动是否增加了价值，或者最初的强烈干预是否足以产生测量到的影响？(4)基线实践的哪些内部背景或结构特征最有可能与绩效改善相关(例如，EHR的广泛使用，适应储备或变化处理能力的程度，执业医生的数量，(5)VPCTC是否提高了小医生执业的能力，以实施未来的PCOR结果并持续提高质量？(6)干预的哪些要素对医生的QI能力建设最重要？将对临床表现和调查数据进行多元统计建模，以回答问题1、3和4。定性访谈、调查和调查结果的统计分析将回答问题2、5和6。

 DESCRIPTION (provided by applicant): Restoring Primary Care in Virginia: PCOR Learning as a Pathway to Value is an extension of the Virginia Center for Health Innovation's (VCHI) work to address primary care transformation in its Virginia Health Innovation Plan. VCHI, in partnership with four of Virginia's schools of medicine, the Virginia Center for Health Quality (VHQC), and evaluation specialists at George Mason University, will form the Virginia Primary Care Transformation Collaborative (VPCTC). They will use an evidence-based, comprehensive strategy to help up to 300 small-to-medium sized primary care practices: 1) accelerate incorporation of PCOR clinical and organizational findings into practice with an initial focus on cardiovascular health and the ABCS; 2) increase their capacity to integrate new PCOR findings on an on-going basis; and 3) learn strategies that can help them sustain and revitalize their organizations while restoring the joy to primary care practice. Practice supports will include on-site coaching, expert consultation, collaborative learning events, an online support center, and data feedback and benchmarking. As a result of this project, "Restoring Primary Care in Virginia," participating practices will develop stronger QI capacity and learn strategies that can help them sustain and revitalize their organizations while restoring the joy to primary care practice. The value proposition to recruit and retain participating practices includes: Improved financial performance; improved clinician, staff, and patient satisfaction; objectively improved quality of care; improved ability to negotiate for and receive pay for performance bonuses, including EMR meaningful use stage 2; completion of Part IV certification by the ABFM and ABIM for QI work completed in this initiative; and engagement in a self- sustaining learning collaborative of similar practices after the end of the project. The evaluation plan is designed to answer these questions: (1) Did the VPCTC intervention improve the performance of small physician practices in Virginia as measured by the individual ABCS? (2) Which elements of the intervention were most important to the physicians for performance improvement? (3) Did "maintenance" or follow-up intervention activities add value or was the initial intense interventio enough to produce the measured impact? (4) Which internal contextual or structural features of practices at baseline are most likely to be associated with improved performance (e.g., expansive use of EHRs, degree of adaptive reserve or change processing capacity, number of physicians in the practice, etc.)? (5) Did the VPCTC improve the capacity of small physician practices to implement future PCOR findings and improve quality on an ongoing basis? (6) Which elements of the intervention were most important to the physicians for QI capacity building? Multivariate statistical modeling of clinical performance and survey data will be performed to answer questions 1, 3, and 4. Qualitative interviews, surveys and statistical analysis of survey results will answer questions 2, 5, and 6.