Strategies for Improving the Quality of Preventive Services in Primary Care

描述(由申请人提供)：吸烟、危险饮酒、不良饮食和缺乏体力活动是许多慢性病的危险因素，目前是美国可预防的死亡和残疾的主要原因。根据美国预防服务工作组的说法，减少疾病和残疾最有效的干预措施之一是那些针对患者个人健康习惯的干预措施。虽然初级保健实践处于改善患者健康的有利地位，但这些机会往往被错过。这项研究的目的是研究如何利用初级保健环境中的质量改进战略来增强这些机会。这项研究的动机是我的职业目标，即进行严格的研究，向实践、提供者和患者层面的变化提供信息，以改善护理提供过程和健康结果。目前的提案与一项国家研究议程保持一致，该议程旨在通过改善医疗体系多个层面的提供结构和流程来提高医疗质量。在这项提案中，我将追求以下目标：1)评估慢性护理模式作为一种系统重新设计的战略，以改善预防护理过程和患者结果，如健康危险行为和生活质量；2)检查绩效工资作为一种财务战略，以改进以预防为导向的实践结构、护理过程和患者结果的质量；3)评估团队合作和员工参与决策作为预防质量倡议管理战略的影响；4)评估提高行为干预质量的国家倡议的外部有效性，并描述参与这项以实践为基础的研究的促进者和障碍；5)对项目进行可持续性研究，并建议在临床实践中保持已证实的干预措施的战略，即将研究转化为实践。这项拟议的研究将对已被推荐用于改善医疗保健结构、流程和结果的概念模型进行实证检验。计划中的研究将利用从资助AHRQ实践的研究网络的国家倡议收集的横断面和纵向数据，以开发现实世界初级保健实践中的行为改变干预措施。将使用混合方法，包括根据拟议的职业发展计划将获得的新的定性研究技术和先进的定量方法。

DESCRIPTION (provided by the applicant): Tobacco use, risky drinking, poor diet, and physical inactivity are risk factors for many chronic diseases, and are currently the nation's leading causes of preventable death and disability. According to the U.S. preventive Services Task Force, among the most effective interventions for reducing disease and disability are those that address patients' personal health habits. While primary care practices are well-positioned to improve patient health, these opportunities are often missed. The purpose of this research is to examine how these opportunities can be enhanced using strategies for quality improvement in primary care settings. This research is motivated by my career goals of conducting rigorous research that informs change at the practice, provider, and patient levels to improve care delivery processes and health outcomes. The current proposal is aligned with a national research agenda to improve healthcare quality by improving delivery structures and processes at multiple levels of the healthcare system. In this proposal, I will pursue the following aims: 1) evaluate the Chronic Care Model as a system redesign strategy to improve preventive care processes and patient outcomes such as health risk behaviors and quality of life; 2) examine pay for performance as a financial strategy to improve the quality of prevention-oriented practice structures, care processes, and patient outcomes; 3) assess the impact of teamwork and staff participation in decision making as management strategies for quality initiatives in prevention; 4) evaluate the external validity of a national initiative to improve the quality of behavioral interventions, and describe facilitators and barriers to participating in this practice-based research; 5) conduct a sustainability study of projects and recommend strategies for maintaining proven interventions in clinical practice, i.e., for translating research into practice. The proposed research will empirically examine conceptual models that have been recommended for improving healthcare structures, processes, and outcomes. Planned studies will leverage both cross sectional and longitudinal data gathered from a national initiative funding AHRQ practice-based research networks to develop behavior change interventions in real-world primary care practices. Mixed methodology will be used, including new qualitative research techniques and advanced quantitative methods that will be acquired as a result of the proposed career development plan.