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针对疾病的指南制定者推荐了一些循证预防服务，但大多数这些服务的提供仍然不是最佳的。一些原因包括缺乏时间和工作人员、补偿机制不协调以及缺乏协调。护理模式建议使用登记处来推动以人口为基础的前瞻性护理。医学研究所敦促初级保健和公共卫生更紧密地结合在一起。责任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合作。我们建议实施、评估和推广一种可持续的、以县为基础的预防服务提供模式，在这种模式中，健康协调员(WCs)与初级保健实践(PCP)、县卫生部门(CHD)和医院合作，帮助患者获得循证预防服务。这些实体将通过县健康改善组织(CHIOS)联系起来，我们目前正在俄克拉何马州发展该组织，作为联邦资助的IMPACT项目的一部分。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接的登记处，这些工具也通过区域卫生信息交换系统与实践记录相联系。通过这一登记，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干预措施后预期寿命的变化。除了WCS和登记职能外，我们还将帮助PCP制定系统的流程，使用既定的实施战略(绩效反馈、学术细节和实践促进)来解决烟草使用和缺乏身体活动的问题。补助资金将由参与县用于最初的广告和促销，并用于妇女委员会工资和福利的50%，其余部分将由县以实物捐助。PI和QI协调员将负责项目管理、WC培训、监督IT接口开发以及PCP培训和支持。我们将记录各种标准的背景变量，跟踪预防性服务清单的交付，并记录估计预期寿命的变化。一个单独的财务分析小组将分析成本和财务收益，并编制适当的报告。成本和收益将从CHDS、初级保健医生和医院的角度进行跟踪。随着福利的增加，Chios将承担更多的财务责任，赠款资金将用于将该模式推广到更多的县。PI和财务分析小组将编写一本指南，供希望复制该模式的其他县使用。我们预计，该模式将根据其基线将预防服务的提供/接收增加10%-40%，将参与服务的人口的平均预期寿命(LE)增加3-6个月，并为CHDS、医院和初级保健医生产生2.5：1的财务投资回报。总而言之，我们将使用先进的卫生信息技术和既定的实施战略，增加向3个农村县20个初级保健诊所的约59名临床医生护理的约70,000人提供循证预防服务。然后，通过传播所获得的信息，我们将使其他县更容易实施类似的模式。该项目将推进AHRQ的一些优先研究领域，包括农村和服务不足人群的护理协调、预防、卫生信息技术/交流、以患者为中心的护理、初级保健重新设计和人口健康。

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.