Center for Research Strategies, University of Colorado Health Sciences Center, Denver, CO, USA.
Health Aff (Millwood). 2011 Mar;30(3):439-45. doi: 10.1377/hlthaff.2010.0159.
Many commentators view the conversion of small, independent primary care practices into patient-centered medical homes as a vital step in creating a better-performing health care system. The country's first national medical home demonstration, which ran from June 1, 2006, to May 31, 2008, and involved thirty-six practices, showed that this transformation can be lengthy and complex. Among other features, the transformation process requires an internal capability for organizational learning and development; changes in the way primary care clinicians think about themselves and their relationships with patients as well as other clinicians on the care team; and awareness on the part of primary care clinicians that they will need to make long-term commitments to change that may require three to five years of external assistance. Additionally, transforming primary care requires synchronizing practice redesign with development of the health care "neighborhood," which is made up of a broad range of health and health care resources available to patients. It also requires payment reform that supports practice development and a policy environment that sets reasonable expectations and time frames for the adoption of appropriate innovations.
许多评论员认为，将小型独立的初级保健实践转变为以患者为中心的医疗之家，是创建更高效的医疗保健系统的重要步骤。该国的第一个全国性医疗之家示范项目于 2006 年 6 月 1 日至 2008 年 5 月 31 日运行，涉及 36 个实践，表明这种转变可能是漫长而复杂的。除其他特点外，转型过程需要组织学习和发展的内部能力；初级保健临床医生对自己以及他们与患者和护理团队其他临床医生的关系的看法的变化；以及初级保健临床医生意识到他们将需要做出长期承诺来改变，这可能需要三到五年的外部帮助。此外，转变初级保健需要将实践重新设计与医疗保健“邻里”的发展同步进行，医疗保健“邻里”由广泛的可向患者提供的健康和医疗保健资源组成。它还需要支付改革来支持实践发展，以及一个政策环境，为采用适当的创新设定合理的期望和时间框架。
