Case Studies on the Cost of Medical Home Transformation and Maintenance in the Sa

描述(由申请人提供)：关于安全网中医疗之家改造和维护成本的案例研究虽然关于以患者为中心的医疗之家(PCMH)的研究越来越多，但很少有研究从预期实施该模式的初级保健提供者的角度评估PCMH的成本。大多数关于PCMH成本的研究都集中在通过预防急诊科就诊和住院来节省系统层面的成本；然而，大多数初级保健提供者并没有从这些节省中获得经济上的好处。此外，虽然关于PCMH的实践成本的文献很少，但我们不知道现有的任何研究既涉及实践的长期维护成本，也没有按实践类型比较成本经验。在这个为期18个月的奖励期间，我们建议扩大我们在安全网医疗之家倡议中对PCMH转型实践成本的分析，该倡议是一个示范项目，由科罗拉多州、爱达荷州、马萨诸塞州、俄勒冈州和宾夕法尼亚州正在转型为PCMH的65家初级保健实践组成。我们这项研究的主要目的是(1)评估PCMH改造的长期维护成本，以及(2)评估不同类型的PCMH成本体验的差异。我们的研究旨在为我们提供关于PCMH实践成本的知识，这些成本在实践促进者完成工作后是增加、减少还是保持稳定，以及成本体验在城市和农村实践之间还是在大小实践之间是不同的。这项研究的发现应该与那些试图在知情的情况下决定采用PCMH模式的初级保健机构相关。我们认为，本提案中描述的每个结果都是整个实践中的信息关键点 该国将需要了解情况，以便在知情的情况下决定进行PCMH改造。政策制定者和研究人员也可能会发现我们的结果很有用，因为他们解决了如何以一种将导致持久变化的方式激励PCMH转型的关键问题。我们对PCMH转型的维护和成本的研究可以更好地洞察资助PCMH转型的政策的长期投资回报，同时也指出了提高可持续性的特定领域。我们通过环境对PCMH成本经验的比较评估可以洞察一些实践环境(例如农村或小型实践)是否需要为PCMH转型提供更多支持。从这些案例研究中收集的数据将有助于描绘一幅重要的图景，说明 医疗院的改造是随着时间的推移进行的各种实践。

DESCRIPTION (provided by applicant): Case Studies on the Cost of Medical Home Transformation and Maintenance in the Safety Net While there is a large and growing body of research developing on the patient-centered medical home (PCMH), few studies have assessed the cost of the PCMH from the perspective of the primary care providers that are expected to implement the model. Most research about PCMH cost has focused on system-level cost- savings through prevention of emergency department visits and hospitalizations; however, most primary care providers do not benefit financially from those savings. Further, while a small body of literature exists on the practice costs of the PCMH, we are not aware of any existing studies that address either the long-term maintenance cost to the practice or the comparative cost experience by practice type. During this 18-month award, we propose an expansion of our analysis of practice costs of PCMH transformation in the Safety Net Medical Home Initiative, a demonstration project comprised of 65 primary care practices in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania that are transforming to become PCMHs. The principal aims of this expansion of our study are to (1) assess the long-term maintenance costs of PCMH transformation and (2) assess differences in PCMH cost experience by type of practice. Our study aims will provide us with knowledge about PCMH practice costs, whether these costs increase, decrease or remain stable after practice facilitators complete their work, and whether the cost experience is different between urban and rural practices or large and small practices. The findings from this study should be relevant for primary care settings who are attempting to make informed decisions on adopting the PCMH model. We believe that each of the outcomes described in this proposal is a critical point of information that practices across the country will need to understand in order to make informed decisions to undergo PCMH transformation. Policymakers and researchers will also likely find our results useful as they address critical questions of how to incentivize PCMH transformation in a way that will result in lasting change. Our study of maintenance of PCMH transformation and costs can provide improved insight on the long-term return on investment for policies that fund PCMH transformation, while also pointing to specific areas to improve sustainability. Our comparative assessment of PCMH cost experience by setting can provide insight on whether some practice settings (e.g. rural or small practices) may require more support for PCMH transformation. The data collected from these case studies will help to paint an important picture of what the costs of medical home transformation are for a variety of practices over time.