Identifying Best Practices of Medical Home Implementation for Older Adults

描述(由申请人提供)：拟议的研究审查初级保健提供者(PCP)和护士如何在他们的实践中实施以患者为中心的老年人医疗之家原则(PCMH)。它采取定性的方法来探索PCP和护士在PCMH护理方面的老年护理经验，并确定这些经验产生的提供者信念、知识和学习。然后，这项研究将确定的经验、信念、知识和学习与特定的战略、方法和活动联系起来，当提供者试图更有效地向他们的老年患者提供一种或多种PCMH护理原则时，这些策略、方法和活动就是提供者参与的。这些“实施最佳实践”将根据特定的PCMH原则进行分类，并可在从事医疗家庭护理的初级保健工作环境中得到验证和进一步应用。共有60名专科医生和护士将为该项目进行面试。此外，还将举行两个焦点小组，即初级保健医生和护士，以帮助验证和完善面谈结果。这项探索性研究的最终结果有两个方面：(A)丰富描述了一组为老年人提供PCMH护理的PCP和护士的日常经验、知识获取和学习积累，以及(B)可能改善老年人PCMH护理服务的实施最佳实践(战略、方法和活动)的类别。这项研究在几个方面都是创新的。首先，它是由一个普遍的观念驱动的，即没有一种“一刀切”的方法来实施PCMH。这证明了核心重点是获得关于PCP的知识和护士为重要的患者亚群实施黄金标准PCMH原则的经验。这一领域的许多现有研究还没有检查该模型在特定患者亚群(如老年人)中的实施经验。因此，该项目通过确定与获得初级保健服务的老年人口的独特需求和特征密切一致的PCMH实施最佳做法，填补了一个必要的经验空白。此外，研究方法是新颖的，因为它应用了一种社会心理学的、基于机构的视角来思考如何思考疗养院的实施和衡量问题。这将是已知的第一项研究之一，从初级保健提供者与其老年患者之间发生的日常社会互动和交流的角度来检查PCMH的实施和衡量。它的社会学取向补充了研究PCMH的研究人员大量使用的经济和结构视角，通过这种方式为我们理解PCMH的实施增加了新的知识。从应用的角度来看，通过访谈数据产生的丰富描述和由此确定的实施最佳做法将传播给从事PCMH护理的其他组织。然后，这些组织可以利用这些知识并使用它来改进他们自己的PCMH实施过程。

DESCRIPTION (provided by applicant): The proposed study examines how primary care providers (PCP) and nurses implement patient-centered medical home principles (PCMH) for older adults in their practices. It takes a qualitative approach in exploring PCP and nurse experiences with PCMH care for older adults, and in identifying provider beliefs, knowledge, and learning produced by these experiences. The study then links the experiences, beliefs, knowledge, and learning identified to specific strategies, approaches, and activities in which providers engage when attempting to provide one or more PCMH care principles more effectively to their older adult patients. These "implementation best practices" will be categorized by specific PCMH principle and can be validated and applied further across primary care work settings doing medical home care. A total of sixty PCPs and nurses will be interviewed for the project. In addition, two focus groups of PCPs and nurses will be held to help validate and refine the interview findings. The end product of this exploratory study is two-fold: (a) rich description of the everyday experiences, knowledge gains, and learning accumulation for a group of PCPs and nurses doing PCMH care for older adults, and (b) categories of implementation best practices (strategies, approaches, and activities) that could potentially improve PCMH care delivery for older adults. The study is innovative in several ways. First, it is driven by the general notion that there is not a "one-size-fits- all" approach to PCMH implementation. This justifies the core focus on gaining knowledge around PCP and nurse experiences implementing gold-standard PCMH principles for an important patient subgroup. Much of the extant research in this area has not yet examined the model's implementation experiences with specific patient subpopulations such as older adults. Thus, the project fills a needed empirical gap by identifying PCMH implementation best practices that are aligned closely with the unique needs and characteristics of older adult populations accessing primary care services. In addition, the study approach is novel because it applies a social psychological, agency-based perspective on the question of how to think about medical home implementation and measurement. This would be one of the first known research studies to examine PCMH implementation and measurement from the perspective of the everyday social interactions and exchanges occurring between primary care providers and their older adult patients. Its sociological orientation complements the economic and structural perspectives that researchers studying the PCMH have largely used, in this way adding new knowledge to our understanding of PCMH implementation. From an applied perspective, the rich description produced through interview data and the resulting implementation best practices that get identified will be disseminated to other organizations engaging in PCMH care. These organizations can then take this knowledge and use it to improve their own PCMH implementation processes.