Understanding the Transformation Experiences of Small Practices with NCQA's Med

描述（由申请人提供）：以患者为中心的医疗之家（PCMH）的概念作为改善护理的潜在手段正在受到越来越多的关注。支付者、购买者和政策制定者将其视为降低成本和提高质量的工具，部分原因是通过重振初级保健。了解小诊所的实践转变可以帮助我们加快PCMH的采用，因为这个国家绝大多数的初级保健都是通过小诊所提供的，但迄今为止，大多数关于质量改进的研究都集中在大型医疗集团上。我们建议利用一个国家的做法，已证明实施PCMH模式的名单，通过NCQA的医生实践连接（R）-以病人为中心的医疗之家”（PPC（R）-PCMH）计划实现认可。这些标准是根据研究、咨询小组、试点测试和公众意见制定的，并得到了国家质量论坛、许多医生组织和利益相关者的认可，作为PCMH示范项目合格实践的标准化工具。在获得认可的诊所中，超过一半的诊所只有不到5名医生。这些小型诊所位于14个不同的州，规模、所有权和服务的患者人群各不相同。基于我们与领先研究人员在质量改进方面的持续合作，我们将：1）详细说明已成功实施PCMH模型的小型医生实践的转型过程（基于3级PPC-PCMH识别的实现），并代表不同的州、组织特征、PCMH示范项目和患者人群; 2）确定组织和环境因素，区分实践与更高水平的PCMH实施（基于第3级认可）与执行水平较低的国家相比（1级或2级）在300个代表不同国家、组织特征、示范项目和患者人群的小型实践中; 3）比较具有较高与较低PCMH实施水平的300个小型实践中的医生经验;和4）比较300个具有较高和较低PCMH实施水平的小型实践中的运营成本和收入。我们将使用10个实践的有目的样本的案例研究，以收集有关转型过程的定性和定量信息，并确定变革的关键障碍和支持。然后，我们将进行一项全国性的调查，300个小的做法与PPC-PCMH承认，以获得更多的普遍知识的做法转变。这项研究将提供一个前所未有的看看在小的做法，支持PCMH实施的因素，并将使我们能够确定的类型的支持，成功的PCMH实施以及实践成本/收入和医生的工作经验的影响是至关重要的。NCQA与多个利益相关者有着密切的联系，我们有一个独特的机会将这些发现传播给全国观众，并利用这些结果为我们的项目提供信息。 公共卫生相关性：付款人，购买者和政策制定者将以患者为中心的医疗之家视为降低成本和提高质量的工具，部分原因是通过振兴初级保健。本研究将10个案例研究与对300个实施医疗之家的小型实践的全国调查配对，以探索转型过程。这项研究将提供一个前所未有的看看在小的做法，支持PCMH实施的因素，它将使我们能够确定的类型的财政和其他支持，是成功的PCMH实施以及PCMH实施的实践成本/收入和医生的工作经验的关系至关重要。

DESCRIPTION (provided by applicant): The concept of a Patient-Centered Medical Home (PCMH) is receiving increased attention as a potential means to improve care. Payers, purchasers, and policy makers see it as a vehicle for moderating costs and improving quality, in part through revitalizing primary care. Understanding practice transformation in small practices can help us accelerate the adoption of the PCMH, since the vast majority of primary care in this country is provided through small practices, yet most of the research to date on quality improvement has focused on large medical groups. We propose to take advantage of a national list of practices that have demonstrated implementation of PCMH model by achieving recognition through NCQA's Physician Practice Connections(R)--Patient-Centered Medical Home" (PPC(R)-PCMH) program. These standards were developed from research, advisory groups, pilot tests and public comment and are endorsed by the National Quality Forum, numerous physician organizations, and stakeholders as a standardized tool for qualifying practices for PCMH demonstration projects. Over half of the practices that have achieved recognition have fewer than 5 physicians. These small practices are located in 14 different states and vary in size, ownership, and patient populations served. Building on our ongoing collaboration with leading researchers on quality improvement, we will: 1) Detail the transformation process among small physician practices that have successfully implemented the PCMH model (based on achievement of Level 3 PPC-PCMH recognition) and that represent diverse states, organizational characteristics, PCMH demonstration programs, and patient populations; 2) Identify organizational and contextual factors that distinguish practices with a higher level of PCMH implementation (based on Level 3 recognition) compared to those with lower levels of implementation (Level 1 or 2) among 300 small practices representing diverse states, organizational characteristics, demonstration programs, and patient populations; 3) Compare physician experiences among 300 small practices with higher versus lower levels of PCMH implementation; and 4) Compare operational costs and revenue among 300 small practices with higher versus lower levels of PCMH implementation. We will use case studies of a purposive sample of 10 practices to gather both qualitative and quantitative information on the process of transformation as well as to identify key barriers and supports for change. We will then conduct a national survey of 300 small practices with PPC-PCMH recognition to gain more generalizable knowledge about practice transformation. This study will provide an unprecedented look at the factors that support PCMH implementation in small practices, and will allow us to identify the types of supports that are critical to successful PCMH implementation as well as the impact on practice costs/revenues and physician work experiences. With NCQA's strong ties to multiple stakeholders, we have a unique opportunity to disseminate these findings to a national audience and to use the results to inform our programs. PUBLIC HEALTH RELEVANCE: Payers, purchasers, and policy makers see the Patient-Centered Medical Home as a vehicle for moderating costs and improving quality, in part through revitalizing primary care. This study pairs 10 case studies with a national survey of 300 small practices that have implemented the medical home to explore the transformation process. This study will provide an unprecedented look at the factors that support PCMH implementation in small practices, and it will allow us to identify the types of financial and other supports that are critical to successful PCMH implementation as well as the relationship of PCMH implementation to practice costs/revenues and physician work experiences.