Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Ann Fam Med. 2010;8 Suppl 1(Suppl 1):S21-32; S92. doi: 10.1370/afm.1111.
We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes.
An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site).
The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process.
The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning.
我们全面介绍了国家示范项目（NDP）干预措施，旨在将家庭实践转变为以患者为中心的医疗之家。
一个独立的评估小组使用多种数据源和方法来描述 NDP 的设计和实施。这些方法包括直接观察实施团队和项目会议、对实践的实地考察、对实践成员和实施团队成员的深入访谈、访问实践沟通（例如，电话、电子邮件）以及公共领域的材料（例如，NDP 网站）。
美国家庭医生学会创建了一个名为 TransforMED 的新部门，该部门于 2006 年 6 月启动了为期 24 个月的 NDP。从完成广泛在线申请的 337 家家庭医学实践中，选择了 36 家并随机分为促进组，该组接受 TransforMED 提供的量身定制、强化的帮助和服务，或自我指导组，该组仅接受非常有限的帮助。来自金融、实践管理和组织心理学等不同背景的 3 名促进者使用多种实践变革策略，包括实地考察、电子邮件、指标和学习会议。自我指导的实践主要是自行开展工作，但在项目中途自行组织了一次务虚会。项目的干预模型发展为与以患者为中心的医疗之家的新兴国家共识原则一致。独立评估小组研究了 NDP 并提供了持续的反馈意见，以告知实施过程。
NDP 表明，复杂的实践变革干预措施必须在干预模型、实施策略和评估方面具有灵活性，以最大限度地提高持续学习。
