Medical Home Transformation in Pediatric Primary Care - What Drives Change

描述（由申请人提供）：儿科初级保健中的医疗之家转型-是什么推动了变革研究将确定医疗之家转型的驱动因素和障碍，以及10个转型的初级保健儿科以家庭为中心的医疗之家（FCMH）的可持续性。长期目标包括：1）确定影响转型的关键内部和外部因素; 2）描述用于维持转型的商业模式; 3）评估促进，技术援助和其他质量改进支持的贡献; 4）评估转型对员工，患者和家庭的影响; 5）确定与成人护理模式相比，儿科医疗之家和儿科实践转变的独特特征; 6）将研究结果传达给多个利益相关者，包括实践，政策制定者，支付者，家庭和医学教育工作者和培训计划。10个转化儿科实践和三个替代品被确定从最高性能的做法，在参加为期两年的国家医疗家庭学习合作在2003年和2006年之间的基础上，他们的合作前和合作后的医疗家庭指数（MHI）分数之间的改善。所有的做法将完成CMHI TAPPP差距分析工具，其中包括MHI和评估医疗家庭质量的一些方面，包括准备NCQA承认。一个旅行研究小组将审查TAPPP数据，然后访问所有十个实践，与关键实践工作人员和患有和不患有慢性疾病的儿童的父母进行多次半结构化访谈。TAPPP得分最高的五个实践将提供与护理质量相关的额外定量数据，包括150个图表审计和CAHPS 2对每个实践中30个家庭的调查。面试结果分析将使用NVIVO 8软件进行主题分析。将对定量调查和图表审计数据进行分析，以确定质量指标，这些指标将纳入对五个高绩效实践的访谈分析。研究结果将通过与美国儿科学会及其国家家庭医疗实施中心的合作进行传播。 公共卫生相关性：这项研究的相关性涉及到广泛的信念，即改造后的初级保健不仅会产生更好的健康结果，而且还会降低成本，增加初级保健职业的吸引力。这项研究将加强对儿科护理转型所需因素的理解，并在医疗家庭转型运动的背景下维持以儿科家庭为中心的医疗家庭，该运动主要集中在成人医疗保健方面。

DESCRIPTION (provided by applicant): The Medical Home Transformation in Pediatric Primary Care - What Drives Change study will identify the drivers and obstacles to medical home transformation and to the sustainability of change in 10 transformed primary care pediatric family-centered medical homes (FCMH). The long-term objectives include: 1) identify key internal and external factors affecting transformation; 2) describe the business models used to sustain transformation; 3) evaluate the contribution of facilitation, technical assistance, and other quality improvement supports; 4) assess transformation's impact on staff, patients, and families; 5) identify characteristics unique to the pediatric medical home and pediatric practice transformation compared to the adult care models; 6) communicate findings to multiple stakeholders included practices, policy makers, payers, families, and medical educators and training programs. Ten transformed pediatric practices and three alternates were identified from among the highest performing practices in taking part in two yearlong national medical home learning collaboratives between 2003 and 2006 based on improvements between their pre- and post-collaborative Medical Home Index (MHI) scores. All practices will complete the CMHI TAPPP gap analysis tool, which includes the MHI and assesses medical home qualities on a number of dimensions including readiness for NCQA recognition. A traveling study team will review the TAPPP data and then visit all ten practices to conduct multiple semi-structured interviews with key practice staff and parents of children with and without chronic conditions. The five practices with the highest TAPPP scores will provide additional quantitative data related to quality of care including 150 chart audits and CAHPS 2 surveys of 30 families from each practice. Analysis of interview results will be subjected to a thematic analysis using NVIVO 8 software. Quantitative survey and chart audit data will be analyzed for indicators of quality that will be incorporated into the analysis of the interviews from the five high- performing practices. Results will be disseminated through a partnership with the American Academy of Pediatrics and its National Center for Medical Home Implementation. PUBLIC HEALTH RELEVANCE: The relevance of this study pertains to the widespread belief that transformed primary care will not only produce improved health outcomes, but also reduce costs and increase the attractiveness of careers in primary care. This study will enhance understanding of the factors needed to transform pediatric care and sustain a pediatric family-centered medical home in the context of a medical home transformation movement that has been largely focused on adult health care.