Rittenhouse Diane R, Thom David H, Schmittdiel Julie A
Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, MU 308-E, San Francisco, CA, USA.
J Gen Intern Med. 2010 Jun;25(6):593-600. doi: 10.1007/s11606-010-1289-x.
The Patient-Centered Medical Home (PCMH) is a widely endorsed model of delivery system reform that emphasizes primary care. Pilot demonstration projects are underway in many states, sponsored by Medicare, Medicaid, major health plans and multi-payer coalitions.
In this paper we consider the development of a long-term policy-relevant research agenda on outcomes of the PCMH. We provide an overview of potential measures of PCMH impact, identify measurement challenges and recommend areas for further study. Although the PCMH should not be expected to solve every problem in the health care system, developing a research agenda for measuring outcomes of delivery system innovations such as the PCMH should be considered in the context of the larger effort to improve the US health care system, with the ultimate goal to improve population health.
As a framework for our discussion, we have chosen the Institute of Medicine's six specific aims for 21st century health care: (1) safe, (2) effective, (3) patient-centered, (4) timely, (5) efficient and (6) equitable. In addition, we include potential areas of PCMH outcomes that do not easily fall under this framework and consider unintended consequences.
Multi-stakeholder involvement will be essential in developing a long-term policy-relevant research agenda for outcomes of the PCMH.
以患者为中心的医疗之家（PCMH）是一种得到广泛认可的医疗服务体系改革模式，强调初级医疗保健。由医疗保险、医疗补助、主要健康计划和多支付方联盟赞助的试点示范项目正在许多州开展。
在本文中，我们考虑制定一项与政策相关的长期研究议程，以研究PCMH的成效。我们概述了PCMH影响的潜在衡量指标，确定了衡量方面的挑战，并推荐了进一步研究的领域。虽然不应期望PCMH解决医疗保健系统中的每一个问题，但在为改善美国医疗保健系统所做的更大努力的背景下，应考虑制定一个研究议程，以衡量诸如PCMH等医疗服务体系创新的成效，最终目标是改善人群健康状况。
作为我们讨论的框架，我们选择了医学研究所提出的21世纪医疗保健的六个具体目标：（1）安全，（2）有效，（3）以患者为中心，（4）及时，（5）高效，（6）公平。此外，我们纳入了PCMH成效中不易归入该框架的潜在领域，并考虑了意外后果。
多方利益相关者的参与对于制定一项与政策相关的长期研究议程以研究PCMH的成效至关重要。
