Implementing a Sustainable Model for Delivery of Preventive Services in Rural Cou

描述（由申请人提供）：美国预防服务工作组、免疫实践咨询委员会和特定疾病指南制定者推荐了一些基于证据的预防服务，但大多数服务的提供仍然不够理想。一些原因包括缺乏时间和人员、报销机制不一致以及缺乏协调。护理模式建议使用登记来推动主动的、基于人群的护理。医学研究所敦促将初级保健和公共卫生更紧密地结合起来。问责制医疗组织和其他支付改革概念需要初级保健临床医生和医院之间的协作。我们建议实施、评估和推广一种可持续的、以县为基础的农村预防服务提供模式，在这种模式下，健康协调员（WCs）与初级保健实践（pcp）、县卫生部门（CHDs）和医院合作，帮助患者获得基于证据的预防服务。作为联邦资助的IMPaCT项目的一部分，我们目前正在俄克拉荷马州开发的县健康改善组织（CHIOs）将把这些实体联系起来。世界卫生组织将使用与患者门户网站和健康风险评估工具相连的登记处，这些登记处还通过区域卫生信息交换系统与执业记录相连。这一登记处可以跟踪预防性服务的提供和接受情况，并估计个人的预期寿命和预期寿命因干预措施而发生的变化。除了世界卫生组织和登记职能外，我们还将通过既定的实施战略（绩效反馈、学术详细说明和实践促进）帮助pcp制定系统流程来解决烟草使用和缺乏身体活动问题。赠款资金将由参与县用于最初的广告和促销活动，以及WCs工资和福利的50%，其余部分将由县以实物形式捐款。PI和QI协调员将负责项目管理、WC培训、IT接口开发监督以及PCP培训和支持。我们将记录各种标准的上下文变量，跟踪预防性服务列表的交付，并记录估计预期寿命的变化。一个独立的财务分析小组将分析成本和财务效益，并产生适当的报告。将从CHDs、pcp和医院的角度跟踪成本和收益。随着收益的增加，首席信息官将承担更多的财务责任，并将赠款用于将该模式推广到其他县。PI和财务分析小组将编写一份指南，供希望复制该模式的其他国家使用。我们预计，该模式将使提供/接受的预防服务根据其基线增加10-40%，每年参与的平均估计人口预期寿命（LE）增加3-6个月，并为冠心病患者、医院和pcp带来2.5:1的投资回报。总之，我们将利用先进的卫生信息技术和既定的实施战略，在3个农村县的20个初级保健诊所中，向约59名临床医生护理的约7万人提供循证预防服务。然后，通过传播所获得的信息，我们将使其他国家更容易实施类似的模式。该项目将推进若干AHRQ优先研究领域，包括农村和服务不足人口的护理协调、预防、保健信息技术/交流、以病人为中心的护理、初级保健重新设计和人口保健。

DESCRIPTION (provided by applicant): A number of evidence-based preventive services have been recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices, and disease-specific guideline developers but delivery of most of these services remains suboptimal. Some reasons include lack of time and staff, misaligned reimbursement mechanisms, and lack of coordination. The Care Model recommends the use of registries to drive proactive, population-based care. The Institute of Medicine has urged closer alignment of primary care and public health. Accountable Care Organizations and other payment reform concepts require collaboration between primary care clinicians and hospitals. We propose to implement, evaluate, and spread a sustainable, rural county-based preventive service delivery model in which wellness coordinators (WCs), working with primary care practices (PCPs), county health departments (CHDs), and hospitals, help patients obtain evidence-based preventive services. These entities will be linked by County Health Improvement Organizations (CHIOs) that we are developing currently in Oklahoma, as part of the federally funded IMPaCT project. The WCs will use a registry connected to a patient portal and health risk appraisal tool that are also linked to practice records through a regional health information exchange system. This registry makes it possible to track delivery and receipt of preventive services and to estimate individuals' life expectancies and changes in life expectancies in response to interventions. In addition to the WCs and registry functions, we will help PCPs develop systematic processes to address tobacco use and physical inactivity using established implementation strategies (performance feedback, academic detailing, and practice facilitation). Grant funds will be used by the participating counties for initial advertising and promotions and for 50% of the salaries and benefits of the WCs, the remainder to be contributed in-kind by the counties. The PI and QI Coordinator will be responsible for project administration, WC training, supervision of IT interface development, and PCP training and support. We will document a variety of standard contextual variables, track delivery of a list of preventive services, and document changes in estimated life expectancies. A separate Financial Analysis Team will analyze the cost and financial benefits and produce appropriate reports. Costs and benefits will be tracked from the perspectives of the CHDs, PCPs, and hospitals. As benefits accrue, CHIOs will accept more financial responsibility and grant funds will be used to spread the model to additional counties. The PI and Financial Analysis Team will develop a guidebook for use by other counties that wish to replicate the model. We expect that the model will increase delivery/receipt of preventive services by 10-40% depending on their baseline, increase average estimated population life expectancy (LE) by 3-6 months per year of participation, and produce a financial return on investment of 2.5:1 for CHDs, hospitals, and PCPs. In summary, we will use advanced health information technology and established implementation strategies to increase delivery of evidence-based preventive services to approximately 70,000 individuals cared for by about 59 clinicians in 20 primary care practices within 3 rural counties. Then, by disseminating the information gained, we will make it easier for other counties to implement similar models. This project will advance a number of AHRQ priority research areas, including care coordination in rural and underserved populations, prevention, health information technology / exchange, patient-centered care, primary care redesign, and population health.