Estimating Costs of Supporting Safety-Net PCMH Transformation in New Orleans

描述(由申请人提供)：以患者为中心的医疗之家(PCMH)是一种很有前途的模式，可以改变初级保健的组织和提供，以实现高质量、可获得和高效的卫生保健。到目前为止，PCMH的大部分评价都侧重于在大型综合交付系统中提高质量成果的成功。迫切需要了解与支持、实施和维持为美国最脆弱人群(即安全网)服务的中小型初级保健做法进行系统重新设计相关的成本。卡特里娜飓风过后，大新奥尔良的安全网卫生保健系统开始了一项全系统的努力，通过使用PCMH模式重建和改变初级保健，该模式得到了一项名为初级保健准入和稳定赠款(PCASG)的1亿美元联邦拨款的支持。初步结果表明，PCASG诊所之间的护理协调程度得到了改善。我们的长期目标是提供全面的证据，支持在美国实施初级保健实践改革，并将PCASG计划作为2007-2011年的“自然实验”，支持其可持续性。从单个诊所的角度来评估PCMH转型的成本效应，以进一步改进高效、有效和可持续的PCMH模式，缺乏数据。因此，成本评估的主要目的将是量化新奥尔良中小型安全网做法成为多氯甲烷所承担的直接和间接成本，以及多氯甲烷重新设计和实施活动所涉及的外部非财务成本。我们将使用PCASG计划数据，包括患者接诊、服务交付登记、运营预算和收入以及PCMH评分。我们将根据PCASG计划成本类别将总成本划分为安全网实践的直接成本和间接成本(直接成本：临床和专科护理；间接成本：行政管理)。从PCMH诊所和非PCMH诊所得出的成本措施(例如，每名患者每月的成本和每名全职相当于全职医生的成本)将进一步汇总为基线执业费用、PCMH转型的增量成本和执业改变的维持。外部非财务激励措施也将被纳入费用评估。第二个目标将是检查PCASG计划期间初级保健实践中的临床水平特征和成本措施之间的关联。利用PCASG的数据来源，我们将使用差异纵向模型来分析PCASG计划下成本措施的影响因素。这一成本评估项目将为主要利益相关者(如初级保健实践、卫生保健系统、卫生保健支付者和卫生政策制定者)提供关于变革性初级保健实践重新设计和实施的成本信息，并就美国初级保健改革的未来倡议提出建议。

DESCRIPTION (provided by applicant): The patient-centered medical home (PCMH) is one promising model for transforming the organization and delivery of primary care in order to achieve high-quality, accessible, and efficient health care. To date, much of the PCMH evaluation has focused on the success of improving quality outcomes in large integrated delivery systems. There is an urgent need to understand the costs associated with supporting, implementing, and maintaining systematic redesign of small and medium sized primary care practices that serve American's most vulnerable populations (i.e., the safety net). The safety net health care system in Greater New Orleans after Hurricane Katrina embarked on a system-wide effort to rebuild and transform primary care by using the PCMH model, which was supported by a $100-million federal grant called the Primary Care Access and Stabilization Grant (PCASG). The preliminary results have demonstrated an improved patient rating of care coordination among the PCASG clinics. Our long-term goal is to provide comprehensive evidence to support the implementation and sustainability of primary care practice change in the United States using the PCASG program as a "natural experiment" in years 2007-2011. There is a dearth of data to estimate the cost effects of PCMH transformation from the perspective of individual clinics to further improve efficient, effective, and sustainable PCMH models. Therefore, the primary aim of this cost evaluation will be to quantify the direct and indirect costs shouldered by New Orleans small and medium sized safety net practices in becoming PCMHs and external non-financial costs involved in PCMH redesign and implementation activities. We will use the PCASG program data including patient encounters, services delivery register, operating budget and revenues, and PCMH scores. We will separate total costs into direct and indirect costs of safety net practices according to the PCASG program cost categories (direct cost: clinical and specialty care; indirect cost: administrative). The cost measures (e.g., cost per patient per month and cost per full-time equivalent (FTE) physician) derived from PCMH clinics and non-PCMH clinics will be further summarized in terms of baseline practice expense, incremental cost of PCMH transformation, and maintenance of practice change. The external non-financial incentives will also be included in the cost evaluation. The secondary aim will be to examine the associations between clinic-level characteristics and cost measures in primary care practices over the period of the PCASG program. Using the PCASG data sources, we will employ difference-in-difference longitudinal models to analyze the influencing factors of the cost measures under the PCASG program. This cost evaluation project will provide key stakeholders (e.g., primary care practices, health care systems, health care payers, and health policy makers) with information about the costs of transformative primary care practice redesign and implementation and make recommendations on future initiatives for primary care change in the United States.