PA SPREAD: PA Spreading Primary Care Enhanced Delivery Infrastructure

描述(由申请人提供)：以患者为中心的医疗之家(PCMH)已成为改善初级保健提供的一种变革性模式。宾夕法尼亚州(宾夕法尼亚州)拥有美国最大的多付款人支持的初级保健改革计划之一。该计划始于2008年，由州政府牵头，涉及152家初级保健诊所(75%的初级保健诊所少于5个提供者FTE)、780个提供者、17个州最大的商业和医疗补助计划。在我们寻求加强、传播和维持这一转型工作的同时，巴勒斯坦权力机构倡议背后的许多基础设施已经存在。一个由多个利益相关者组成的政府指定的委员会(代表付款人、提供者、医院、企业、有组织的劳工和州政府)开会计划和监督这一倡议。委员会帮助推动了该倡议在全州的传播，改善了临床结果。超过90%的参与实践与国家提高实践绩效计划合作，报告了标准化的月度质量结果。PA的利益相关者一致认为，合作、多付款人的方法对于全业务转型至关重要，这将实现切实和可衡量的医疗质量改善目标，从而降低医疗成本。成功的倡议涉及交错的区域推广，包括(1)学习合作/社区，(2)每月业绩报告，(3)具体的转型预期，(4)以实践为基础的护理管理，(5)实践促进，以及(6)多支付者支持的基础设施支付，以推动PCMH的采用。该项目的目标是通过一个综合的可持续基础设施在成功的基础上再接再厉，该基础设施已准备好在整个PA和其他地区传播。与宾夕法尼亚州地区健康教育中心(PA AHEC)的全州工作人员和实践网络基础设施合作，将使该州进一步传播，并形成初级保健推广服务的全国模式的基础。我们的总体目标是(1)通过课程开发扩大实践便利化，完善学习社区模式，进一步将IT资源转化为实践，并与PA AHEC计划合作测试这些创新，从而增强当前的计划；(2)通过利用AHEC网络建立强大的基础设施，将当前的干预措施传播到整个PA，利用我们当前团队对其他州新兴的全州范围内的多方利益相关者计划的持续支持，并将我们的计划打包，以便有针对性地向至少其他三个州交付，从而传播我们的成功模式和经验。PA的多方利益攸关方合作可以作为初级保健扩展服务的国家模式，将初级保健转变为PCMH，以改善结果和降低成本。

DESCRIPTION (provided by applicant): The Patient Centered Medical Home (PCMH) has emerged as a transformative model to improve primary care delivery. Pennsylvania (PA) has one of the largest multi-payer-supported PCMH efforts to transform primary care in the U.S. The initiative started in 2008, is led by state government, and involves 152 primary care practices (75% with fewer than 5 provider FTEs), 780 providers, 17 of the state's largest commercial and Medicaid plans. As we look to enhance, disseminate and sustain this transformation work, much of the infrastructure behind the PA initiative already exists. A multi-stakeholder, government-appointed commission (representing payers, providers, hospitals, business, organized labor, and state government) meets to plan and oversee the initiative. Commission has helped drive dissemination of the initiative statewide with improved clinical outcomes. More than 90% of the participating practices are reporting standardized monthly quality outcomes in partnership with the national Improving Performance in Practice program. PA's stakeholders have agreed that a collaborative, multi-payer approach is essential to practice-wide transformation that will achieve the goals of tangible and measurable improvement in the quality of care, leading to a reduction in the costs of care. The successful initiative has involved staggered regional rollouts that include (1) learning collaborative/communities, (2) monthly performance reporting, (3) specific transformation expectations, (4) practice-based care management, (5) practice facilitation, and (6) multi-payer supported infrastructure payments to drive PCMH adoption. The project goal is to build on success with an integrated sustainable infrastructure that is ready to be disseminated throughout PA and beyond. Partnering with the statewide staffing and practice network infrastructure of PA Area Health Education Center (PA AHEC) will enable further dissemination across PA and form the basis for a national model for the primary care extension service. Our overall objectives are to (1) Enhance the current initiative by expanding practice facilitation through curriculum development, refining the learning community model, further leveraging IT resources into practices, and testing these innovations in partnership with the PA AHEC program and (2) Disseminate our successful models and lessons learned by harnessing the AHEC network to establish a robust infrastructure to spread the current intervention across all of PA, leveraging our current team's ongoing support for burgeoning statewide multi-stakeholder initiatives in other states, and package our program for targeted delivery to at least three other states. PA's multi-stakeholder collaboration can serve as a national model for the primary care extension service to transform primary care towards PCMH to improve outcomes and lower costs.