Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
AIDS Patient Care STDS. 2013 May;27(5):272-9. doi: 10.1089/apc.2013.0007.
The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.
患者为中心的医疗之家（PCMH）已经被引入，作为提供高质量、综合、以患者为中心的医疗服务的模式，这种服务既容易获得又协调一致，并且可能为优化感染艾滋病毒的青年（YLH）的护理提供一个框架。我们在 2011 年 7 月调查了六家儿科/青少年艾滋病毒诊所，为 578 名患者（中位年龄 19 岁，51%为男性，82%为黑人）提供服务，以评估其符合 PCMH 的程度。诊所完成了一份涵盖 PCMH 的六个领域的 50 项调查：（1）综合护理，（2）以患者为中心的护理，（3）协调护理，（4）便捷服务，（5）质量和安全，以及（6）健康信息技术。为了确定对 PCMH 的一致性，设计了一种新颖的基于点的评分系统。通过诊所对各领域的得分进行制表，以获得对 PCMH 一致性的总体评估。所有六家诊所都做出了回应。总的来说，诊所的 PCMH 措施平均得分 75.8%[95%可信区间，63.3-88.3%]，在以患者为中心的护理（94.7%）、协调护理（83.3%）和质量与安全措施（76.7%）方面得分最高，在健康信息技术（70.0%）、便捷服务（69.1%）和综合护理（61.1%）方面得分最低。诊所中度符合 PCMH 模式。需要改进的领域包括获得护理、综合护理和健康信息技术。需要进一步研究，以确定诊所对 PCMH 模式的更大一致性是否能改善 YLH 的临床结果和成本节约。
