Green Ellen P, Wendland John, Carver M Colette, Hughes Rinker Cortney, Mun Seong K
University of Delaware, 416C Purnell Hall, Newark, DE 19711, USA.
Int J Telemed Appl. 2012;2012:103685. doi: 10.1155/2012/103685. Epub 2012 Aug 30.
The Patient-Centered Medical Home (PCMH) is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA). Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients' needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH.
以患者为中心的医疗之家（PCMH）是一种初级保健模式，为患者提供协调一致的全面护理，以改善健康结果。本文探讨了将传统初级保健实践转变为获得国家质量保证委员会（NCQA）认可的PCMH时出现的实际问题。2010年6月在弗吉尼亚州亚历山德里亚举行的一次PCMH研讨会上收集了各个组织在这一转变过程中的经验。对这些经验的分析与文献综述相结合，以揭示必须以符合实践和患者需求的方式加以应对的常见挑战。这些挑战包括：NCQA指南、促进提供者的认同、利用电子病历、改变办公室文化以及重新调整实践中的工作空间以适应实施PCMH意图所需的服务。NCQA提供了一套实施PCMH模式的标准，但这些标准缺乏许多在实际情况中将会依赖的具体细节。虽然许多研究人员和提供者提出了批评，但我们认为这种模糊性使得实践在实施PCMH时有更大的灵活性。
