Evaluating the Role of a Medical Home Model in the Successful Management of Diabe

描述（由申请人提供）：初级保健医生如何为他们的患者提供护理，可能会减少易受伤害的成年人2型糖尿病（以下简称糖尿病）结局的差异。虽然提供者可能提供良好的护理技术质量（即提供的临床服务和提出的治疗建议），但已知在提供者如何使患者获得这些服务方面存在缺陷，如何与患者就复杂的管理方案进行良好的双向沟通，以及如何与照顾患者病情的其他提供者协调护理。这些缺陷对于脆弱的成年人——种族/少数民族、社会经济地位低的人和依赖国家安全网医疗保健系统的人——尤其严重，并且可能导致糖尿病结局的差异。拟议研究的目的是了解向糖尿病成人提供初级保健服务的方式是否会影响患者最终接受的临床服务，以及患者遵守提供者建议以成功管理其病情的程度。我们认为，有大量证据表明，按照“医疗之家模式”提供护理有助于改善患者体验，并可能改善患者对适当护理的接受和反应。“医疗之家应该方便人们进入，促进与病人的持续关系，包括有效的双向沟通，提供全面的服务，在需要时帮助协调服务，并考虑到家庭背景和文化背景。”具体目标1：检验以下假设：更好的医疗家庭绩效增加了推荐的糖尿病护理的接受度，改善了与更好的病情管理相关的患者生理指标，并减少了不良的医疗保健利用。具体目标2：探讨提供初级保健的实践环境（即社区卫生中心、团体实践和单独实践）是否影响医生的医疗家庭绩效，从而影响患者对糖尿病护理的反应。

DESCRIPTION (provided by applicant): in how primary care physicians deliver care to their patients are likely to reduce disparities in Type 2 diabetes (hereafter referred to as diabetes) outcomes for vulnerable adults. While providers may offer good technical quality of care (i.e., the clinical services provided and therapeutic recommendations made), there are known deficits in how providers make those services accessible to patients, how well two-way communication occurs with patients about complex management regimens, and how care is coordinated with other providers caring for the patients' condition. These deficits are particularly acute for vulnerable adults-racial/ethnic minorities, those with low socioeconomic status and those who rely on the nation's safety net health care system-and are likely to contribute to disparities in diabetes outcomes. The goal of the proposed research is to understand whether the way in which primary care services are delivered to diabetic adults influences what clinical services are ultimately received by patients and how well patients adhere to providers' recommendations to successfully manage their condition. We think, and there is a body of evidence to suggest, that delivering care in accordance with a "medical home model" helps to improve patient experiences and may improve patients' receipt of, and response to, appropriate care. A medical home should be widely accessible, facilitate a continuous relationship with patients including effective two-way communication, provide comprehensive services, help to coordinate services when needed, and account for family context and cultural background throughout. ' Specific Objective 1: To test the hypothesis that better medical home performance increases the receipt of recommended diabetes care, improves patient physiologic measures associated with better management of the condition, and reduces adverse health care utilization. ' Specific Objective 2: To explore whether the practice setting in which primary care is delivered (i.e., community health centers, group practices, and solo practices) affects the medical home performance of physicians and, as a result, the response of patients to diabetes care.