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

 描述（由申请人提供）：恢复弗吉尼亚州的初级保健：PCOR学习作为价值的途径是弗吉尼亚健康创新中心（VCHI）工作的延伸，以解决其弗吉尼亚健康创新计划中的初级保健转型。VCHI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，将成立弗吉尼亚州初级保健转型合作组织（VPCTC）。他们将采用循证综合战略，帮助多达300个中小型初级保健实践：1）加速将变革和组织振兴方案的临床和组织研究结果纳入实践，最初重点是心血管健康和ABCS; 2）提高他们持续整合变革和组织振兴方案新研究结果的能力; 3）学习可以帮助他们维持和振兴组织的策略，同时恢复初级保健实践的乐趣。实践支持将包括现场辅导、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测试。由于这个项目，“恢复在弗吉尼亚州的初级保健”，参与的做法将发展更强的QI能力和学习的战略，可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：提高财务绩效;提高临床医生、工作人员和患者满意度;客观提高护理质量;提高谈判和获得绩效奖金的能力，包括EMR有意义使用阶段2; ABFM和ABIM完成本计划中QI工作的第四部分认证;并在项目结束后参与类似实践的自我维持学习合作。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实践的表现，以个人ABCS衡量？(2)干预的哪些要素对医生的绩效改善最重要？(3)“维持”或后续干预活动是否增加了价值，或者最初的密集干预是否足以产生可衡量的影响？(4)基线实践的哪些内部背景或结构特征最有可能与改进的绩效相关（例如，EHR的广泛使用，适应性储备或变化处理能力的程度，实践中的医生数量等）？(5)VPCTC是否提高了小型医师诊所实施未来变革和组织振兴方案调查结果和持续提高质量的能力？(6)干预的哪些要素对医师进行QI能力建设最重要？将对临床性能和调查数据进行多变量统计建模，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.