Transforming Primary Care Practice in North Carolina

描述(由申请人提供)：以患者为中心的医疗之家(PCMH)模式包括彻底的初级保健实践重新设计，最终目标是提高患者护理质量和降低成本。需要关于实践转变的最佳方法的详细信息，以帮助越来越多的实践，因为它们计划经历这一过程。这项研究的总体目标是评估北卡罗来纳州改善实践绩效计划(NC IPIP)所属初级保健实践的变革性变化的采用和过程，检查变化的特定组成部分如何与关键的健康结果相关，并探索有利于变革性变化的环境、组织和财务条件。本研究的目的是：1)确认在NC IPIP选定的40个实践中发生的变革过程；2)评估变革的哪些组成部分与糖尿病和哮喘的质量护理指标的改善最相关；3)针对12个实践的子集，证明在实施变革方面取得了不同程度的成功，利用定量和定性方法对变革过程有更丰富的了解，检查环境条件、组织特征和财政资源对变革过程的影响，并在实践层面描述变革所涉及的成本，以及4)提供一套可应用于个人实践和卫生保健组织层面的建议，以协助PCMH的转型进程。这项研究的最终目标和意义是描述转型过程，并得出一套可实施的建议，这些建议可以广泛分享，以帮助个人实践和医疗保健组织走向PCMH模式。 公共卫生相关性：以患者为中心的医疗之家(PCMH)描述了促进个别患者和他们的私人医生之间的伙伴关系的卫生保健环境。PCMH模式改善了患者获得护理的机会和护理质量。在这项研究中，研究人员计划评估这一变革性变化的采用和过程，并检查这种变化的特定组成部分如何与关键的健康结果相关。该项目与公共卫生高度相关，因为它将增进对实践中的转变过程的了解，并提供一套可广泛分享的可执行建议，以帮助个人实践和医疗保健组织转向PCMH模式。

DESCRIPTION (provided by applicant): The Patient-Centered Medical Home (PCMH) model involves complete primary care practice redesign with the ultimate goal to improve the quality of patient care and reduce cost. Detailed information on the best methods of practice transformation is needed to help the growing number of practices as they plan to go through this process. The overall objective of this study is to evaluate the adoption and process of transformational change in primary care practices belonging to the North Carolina Improving Performance in Practice program (NC IPIP), examine how specific components of the change relate to key health outcomes and explore environmental, organizational and financial conditions that are conducive to transformational change. The aims of this study are to 1) confirm the transformational change process that has occurred within 40 selected practices in the NC IPIP, 2) evaluate which components of change are most linked with improvement in the quality care indicators for diabetes and asthma, 3) for a subset of 12 practices that evidence varying degrees of success in implementing transformational change, utilize quantitative and qualitative methods to obtain a richer understanding of the change process, examine the effect of environmental conditions, organizational characteristics and financial resources on the change process and describe the costs involved in transformational change at the practice level, and 4) provide a set of recommendations that can be applied at the individual practice level and at the health care organization level to assist in the PCMH transformation process. The ultimate goal and the significance of this study is to describe the transformation process and arrive at a set of implementable recommendations that can be shared broadly to assist individual practices and health care organizations moving toward the PCMH model. PUBLIC HEALTH RELEVANCE: The Patient-Centered Medical Home (PCMH) describes a health care setting that facilitates partnerships between individual patients and their personal physicians. The PCMH model improves patient access to care and quality of care. In this study, the researchers plan to evaluate the adoption and process of this transformational change and examine how specific components of the change relate to key health outcomes. This project is highly relevant to public health as it will enhance understanding of the transformation process in practice and provide a set of implementable recommendations that can be shared broadly to assist individual practices and health care organizations moving toward the PCMH model.