Comparative Effectiveness of Primary Care Practice Transformation by Two Insurers

描述（由申请人提供）：虽然存在大量证据支持高绩效结构和流程与改善人口健康水平之间的积极关系，但对于实现高功能卫生服务系统所必需的交付系统，特别是健康计划的支持类型知之甚少。拟议的研究将审查两种不同的PCMH战略，包括两种不同区域卫生计划所采用的不同付款和便利支助干预措施，在改进试点做法的结果——成本、质量和经验方面的比较效力。卫生服务系统模型为这个评估项目提供了一个概念性框架。拟议的项目是新颖的，因为它包括多种不同实践中的两种不同干预措施，每一种都有比较实践来控制时间和地理趋势。该提案最直接地解决了医学研究所的优先主题，“比较不同质量改进策略在疾病预防、急性护理、慢性疾病护理和不同儿童和成人康复服务方面的有效性。”

DESCRIPTION (provided by applicant): While much evidence exists to support the positive relationship between high performing structures and processes, with improved population level health, little is known about the type of support by the delivery system, particularly health plans, necessary to achieve a high functioning health service system. The proposed research will examine the comparative effectiveness of two different PCMH strategies, including different payment and facilitated support interventions, utilized by two different regional health plans, on improvement in outcomes - cost, quality and experience in pilot practices. The Health Service System model provides a conceptual framework for this evaluation project. The proposed project is novel in that it includes two different interventions in multiple, diverse practices, each with comparison practices to control for temporal and geographic trends over time. This proposal most directly addresses the Institute of Medicine priority topic, "Compare the effectiveness of different quality improvement strategies in disease prevention, acute care, chronic disease care, and rehabilitation services for diverse populations of children and adults." PUBLIC HEALTH RELEVANCE: While much evidence exists to support the positive relationship between high performing structures and processes, with improved population level health, little is known about the type of support by the delivery system, particularly health plans, necessary to achieve a high functioning health service system. The proposed research will examine the comparative effectiveness of two PCMH strategies, including different payment and facilitated support interventions, utilized by two different regional health plans, on improvement in outcomes - cost, quality and experience in pilot practices. The Health Service System model provides a conceptual framework for this evaluation project.