Estimating the Costs of Supporting Primary Care Practice Transformation

描述（由申请人提供）：我们申请R 03研究的资金，以响应AHRQ的RFA-HS-13-003，估计支持初级保健实践转型的成本。虽然越来越多的证据基础记录了初级保健转型的可量化影响，但实施这些转型的成本仍然相对未知。帕洛阿尔托医学基金会（PAMF）是北方加州的一个非营利性多专业团体。PAMF的三个特征使其成为估计与转型初级保健计划相关的成本的理想环境。首先，自2000年以来，PAMF已经成功地重新设计了初级保健服务，并有证据表明质量有所改善，10个PAMF诊所被国家质量保证委员会认定为以病人为中心的医疗之家。第二，作为一个大型的多专业实践，有众多的支付者和医生的补偿反映了收费的服务激励，使PAMF的经验教训适用于广泛的医疗保健提供环境。第三，拟议的研究将扩大以前的工作资助下AHRQ的“改造初级保健”FOA（R18 HS 019167 -01，P.I. Tai-Seale），并将利用有关PAMF实践转型的广泛知识，有关转型对质量改进的影响的持续研究，以及支持和参与PAMF领导人，临床医生和工作人员的网络。拟议项目将采用“以活动为基础的成本计算”方法，从PAMF的角度确定实施主要初级保健举措的成本，包括但不限于共享医疗服务、慢性病患者的团队护理以及通过患者健康记录系统进行的自动实验室订购。具体目标是：（1）确定转型过程的关键组成部分以及直接和间接成本的来源。涉及人力资源的间接成本将根据完成了哪些任务或“活动”、哪些人员参与了每项活动以及每项活动花费了多少时间进行分析。深入的关键线人采访利益相关者从不同层次的组织和不同规模的诊所将与档案（电子邮件消息，日历预约，会议记录）和定量数据从访问日志中获得的电子健康记录，员工时间项目代码，和工资数据进行三角测量;（2）确定我们确定的关键组成部分的成本。所有费用将按国家市场平均数定价，国家薪金数据将用于确定雇员在每项活动上花费的时间的成本。成本将在多个层面上进行分析：医生，诊所，部门和组织，并对服务少数民族和服务不足的患者的诊所进行亚组分析。1

DESCRIPTION (provided by applicant): We apply for funding for an R03 study in response to AHRQ's RFA-HS-13-003, Estimating the Costs of Supporting Primary Care Practice Transformation. While a growing evidence base is documenting the quantifiable impact of primary care transformation, the cost of implementing these transformations remains relatively unknown. The Palo Alto Medical Foundation (PAMF) is a non-profit multispecialty group practice in Northern California. Three characteristics of PAMF make it an ideal setting to estimate the costs associated with transformational primary care initiatives. First, PAMF has been successfully re-designing primary care delivery, with evidence of quality improvements, since 2000 and ten PAMF clinics have been recognized by the National Committee on Quality Assurance as Patient Centered Medical Homes. Second, being a large multispecialty practice with a multitude of payers and having physicians whose compensation reflects fee-for- service incentives make lessons from PAMF applicable to a wide range of health care delivery settings. Third, the proposed study will expand upon previous work funded under AHRQ's "Transforming Primary Care" FOA (R18 HS019167-01, P.I. Tai-Seale) and will leverage extensive knowledge about the transformation of PAMF practices, ongoing research about the impact of the transformation on quality improvements, and a network of supportive and engaged PAMF leaders, clinicians and staff. The proposed project will follow an "activity-based costing" approach to determine the costs of implementing key primary care initiatives, including but not limited to Shared Medical Appointments, Team Care for patients with chronic illnesses, and Automatic Lab Ordering via a Patient Health Record System, from the perspective of PAMF. The specific aims are to: (1) Identify the key components of the transformation process and sources of direct and indirect costs. Indirect costs involving human resources will be analyzed according to what tasks or "activities" were completed, which personnel were involved in each activity, and how much time was spent on each activity. In-depth key informant interviews with stakeholders from different levels of the organization and clinics of varying sizes will be triangulated with archival (e-mail messages, calendar appointments, meeting minutes) and quantitative data obtained from the access log in the electronic health records, employee time project codes, and payroll data; and (2) Determine the costs of the key components we identify. All costs will be priced at national market averages, and national salary data will be used to determine the costs of employee time spent on each activity. The costs will be analyzed at multiple levels: physician, clinic, division, and the organization, with a subgroup analysis of clinics serving minority and underserved patients. 1