A climate for evidence-based practice implementation in the patient-centered medical home

 描述（申请人提供）：美国的医疗保健系统被认为是16个工业国家中最差的，在可接受的死亡率方面，3在可及性和安全性方面排名很低，4并以牺牲更高质量的护理为代价奖励提供的服务数量。2以病人为中心的医疗之家（PCMH）被认为是改善美国健康状况的一项交付系统创新，是当前医疗保健改革工作的基石。7.改革努力的成功将主要从三重目标框架的三个领域来衡量：同时，1）增强患者的护理体验，2）改善人口健康，3）降低医疗保健成本。38 PCMH能否成功实现三重目标，取决于提供经证明有效的治疗和干预措施（即，循证实践（EBP）。在PCMH中有效使用EBP取决于组织中的支持性气氛。14 -15然而，PCMH中的组织气氛在多大程度上支持或阻碍EBP尚不清楚。这种混合方法的研究将评估EBP实施气候（即，组织成员认为采用EBP是期望、支持和奖励的程度）以及PCMH对EBP的态度。本研究将在两个实践中进行，一个已获得NCQA 3级认证的PCMH（PCMH）的认可，另一个计划转变为PCMH（非PCMH）。此外，本研究将评估EBP实施气候和对EBP的态度随着时间的推移在这两个做法的潜在变化。随着时间的推移，了解PCMH和非PCMH实践中EBP实施的环境将有助于为制定促进EBP的战略提供信息，进一步加速PCMH实现三重目标的转型。拟议的研究非常符合AHRQ的使命和研究优先领域#1：通过加速实施以患者为中心的结局研究（PCOR）来提高医疗保健质量。具体而言，该提案的结果将指导旨在通过加速PCMH可持续实施EBP来改善健康和医疗保健质量的干预措施的开发和利用。

 DESCRIPTION (provided by applicant): The United States healthcare system is identified as being the worst of sixteen industrial nations with regard to amenable mortality,3 ranks poorly on access and safety,4 and rewards quantity of services delivered at the expense of higher quality care.2 The patient-centered medical home (PCMH) is considered a delivery system innovation for improving health in the United States22 and is a cornerstone of current health care reform efforts.4-7 The success of reform efforts will be measured primarily across the three domains of the Triple Aim framework: simultaneously 1) enhancing patient experiences of care and 2) improving population health while 3) reducing health care costs.38 The success of the PCMH to achieve the Triple Aim is dependent on the delivery of treatments and interventions with demonstrated effectiveness (i.e., evidence-based practice (EBPs)). Effective use of EBPs in the PCMH is contingent on a supportive climate in the organization.14-15 However, the extent to which the organizational climate in the PCMH supports or impedes EBPs is unknown. This mixed- methods study will assess EBP implementation climate (i.e., the extent to which organizational members perceive that the adoption of EBPs is expected, supported, and rewarded) and attitudes about EBPs in the PCMH. This study will do so in two practices, one that has achieved recognition as an NCQA Level 3 certified PCMH (PCMH), and another that plans to transform into a PCMH (non- PCMH). Additionally, this study will assess potential changes in EBP implementation climate and attitudes about EBPs over time within these two practices. Understanding the climate for EBP implementation in the PCMH and non-PCMH practices over time will help in informing the development of strategies to promote EBPs, further serving to accelerate PCMH transformation toward achieving the Triple Aim. The proposed research study is an excellent fit with the AHRQ's Mission and Research Priority Area #1: Improve health care quality by accelerating implementation of patient centered outcomes research (PCOR). Specifically, results from this proposal will guide the development and utilization of interventions designed to improve health and healthcare quality by accelerating the sustainable implementation of EBPs in the PCMH.