Carney Patricia A, Eiff M Patrice, Green Larry A, Lindbloom Erik, Jones Samuel E, Osborn Jamie, Saultz John W
Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
Fam Med. 2011 Jul-Aug;43(7):464-71.
This study's purpose was to describe the innovations, hypotheses being tested, and measures used in residency training redesign in 14 family medicine residencies associated with the P⁴ project.
We conducted a content analysis of site visit reports to identify and categorize the curricular innovations that are part of the P⁴ Project. Similarly, we cataloged specific hypotheses to be tested and both site-specific measures and core measures collected by the evaluation team to assess hypotheses.
Selected P⁴ programs include three university-based programs; three community-based, university-administered programs, and eight community-based, university-affiliated programs. These 14 programs had 24 continuity clinics, and 334 residents were enrolled in the baseline cohort (2006--2007). Between two and five innovations were proposed by programs in the baseline period linked to 70 planned hypotheses, with a range of three to seven hypotheses (mean of 4.5). Seven programs (50%) focused on Patient-centered Medical Home practice redesign, and seven (50%) assessed different aspects of a 4-year curriculum as the two most common innovations. Team-based care and team training were tested in six programs, and five tested an individualized curriculum tailored to each resident. Eight programs submitted 11 grants, and six programs were successful in obtaining funding to support P⁴ activities. The sources of funding primarily included the Health Resources and Services Administration, US Department of Health and Human Services, and local foundations, and the mean number of dollars attained was $659,528 (range=$50,000--$2,500,000). Seven grants were received through local sources, totaling $3,219,884 with an average of $459,983 per program.
The P⁴ project had a successful launch and to date has retained all 14 programs that started in 2007. Though no direct funding was provided by P⁴ to individual sites, all have focused on important contemporary challenges for training excellent family physicians, all are engaged in important evaluations, and nearly half have successfully obtained project funding to support their specific P⁴ activities during the baseline period.
本研究旨在描述与P⁴项目相关的14个家庭医学住院医师培训项目重新设计中的创新举措、正在检验的假设以及所采用的评估方法。
我们对实地考察报告进行了内容分析，以识别和分类作为P⁴项目一部分的课程创新。同样，我们整理了要检验的具体假设，以及评估团队为评估假设而收集的特定场所措施和核心措施。
入选的P⁴项目包括3个基于大学的项目；3个基于社区、由大学管理的项目，以及8个基于社区、与大学相关的项目。这14个项目有24个连续性诊所，334名住院医师纳入了基线队列（2006 - 2007年）。在基线期，各项目提出了2至5项创新举措，与70项计划中的假设相关，假设数量在3至7项之间（平均4.5项）。7个项目（50%）专注于以患者为中心的医疗之家实践重新设计，7个项目（50%）将4年制课程的不同方面作为最常见的两项创新进行评估。6个项目对团队式护理和团队培训进行了检验，5个项目对为每位住院医师量身定制的个性化课程进行了检验。8个项目提交了11项资助申请，6个项目成功获得资金以支持P⁴活动。资金来源主要包括卫生资源与服务管理局、美国卫生与公众服务部以及当地基金会，获得的平均资金数额为659,528美元（范围 = 50,000美元至2,500,000美元）。通过当地渠道获得了7项资助，总计3,219,884美元，每个项目平均459,983美元。
P⁴项目成功启动，截至目前保留了2007年启动的所有14个项目。尽管P⁴没有直接向各个场所提供资金，但所有项目都关注培养优秀家庭医生的重要当代挑战，都参与了重要评估，并且近一半项目在基线期成功获得项目资金以支持其特定的P⁴活动。
