Reid Alfred, Baxley Elizabeth, Stanek Michele, Newton Warren
Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599-7595, USA.
Fam Med. 2011 Jul-Aug;43(7):487-94.
The Patient-centered Medical Home (PCMH) model provides a roadmap for practices engaged in practice transformation to improve quality, accessibility, and satisfaction. Primary care residencies can use these principles to transform their practices, but it is unclear how best to facilitate this transformation. This paper describes the design, implementation, and initial outcomes of an academic PCMH collaborative.
The I³ PCMH Collaborative adapted the Institute for Healthcare Improvement's Breakthrough Collaborative model to facilitate practice transformation in 25 primary care teaching sites across North Carolina, South Carolina, and Virginia. The National Committee for Quality Assurance (NCQA) PCMH Recognition Program provided the goal and outcome measures. Surveys at baseline, midpoint, and end of the 20-month collaborative period, as well as activity assessments, described practice characteristics, tracked progress, and identified key lessons.
Twelve programs (48%) achieved NCQA PCMH recognition or submitted applications during the collaborative, and nine programs (36%) planned to submit applications by July 2011. A majority of programs characterized improvements toward becoming a PCMH as "significant" (56%) or "sustainable" (12%). Sixteen (64%) programs credited the collaborative with helping to maintain focus on practice transformation in the face of competing priorities. Twenty-one (84%) programs indicated willingness to participate in a future practice improvement collaborative.
A heterogeneous group of primary care residency programs working together can achieve substantial, measurable improvement toward becoming PCMHs, with a modest investment in collaborative infrastructure.
以患者为中心的医疗之家（PCMH）模式为致力于实践转型以提高质量、可及性和满意度的医疗机构提供了路线图。基层医疗住院医师培训项目可以利用这些原则来转变其医疗实践，但尚不清楚如何最好地推动这种转变。本文描述了一个学术性PCMH协作项目的设计、实施及初步成果。
I³ PCMH协作项目采用了医疗改进研究所的突破性协作模式，以促进北卡罗来纳州、南卡罗来纳州和弗吉尼亚州25个基层医疗教学点的实践转型。国家质量保证委员会（NCQA）的PCMH认可项目提供了目标和结果指标。在为期20个月的协作期的基线、中点和结束时进行的调查以及活动评估，描述了实践特征、跟踪了进展情况并确定了关键经验教训。
12个项目（48%）在协作期间获得了NCQA的PCMH认可或提交了申请，9个项目（36%）计划在2011年7月前提交申请。大多数项目将在向PCMH转型方面的改进描述为“显著”（56%）或“可持续”（12%）。16个（64%）项目认为协作有助于在面临相互竞争的优先事项时保持对实践转型的关注。21个（84%）项目表示愿意参与未来的实践改进协作项目。
一群不同类型的基层医疗住院医师培训项目共同努力，只需对协作基础设施进行适度投资，就可以在成为PCMH方面取得实质性的、可衡量的改进。
