Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA.
Ann Fam Med. 2013 May-Jun;11 Suppl 1(Suppl 1):S14-8. doi: 10.1370/afm.1488.
Little is known about reasons why a medical group would seek recognition as a patient-centered medical home (PCMH). We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later.
As part of a larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, and front-line staff. Interviews were conducted according to a guide that evolved during the project and were audio-recorded and fully transcribed. Transcripts were analyzed and thematically coded.
PCMH principles were consistent with the organization's culture and mission, which valued innovation and putting patients first. Motivations for implementing specific PCMH components varied; some components were seen as part of the organization's patient-centered culture, whereas others helped the practice compete in its local market. Informants consistently reported that National Committee for Quality Assurance recognition arose incidentally because of a 1-time incentive from a local group of large employers and because the organization decided to allocate some organizational resources to respond to the complex reporting requirements for about one-half of its clinics.
Becoming patient centered and seeking recognition as such ran along separate but parallel tracks within this organization. As the Affordable Care Act continues to focus attention on primary care redesign, this apparent disconnect should be borne in mind.
对于医疗集团寻求认可为以患者为中心的医疗之家（PCMH）的原因知之甚少。我们研究了一个团体寻求认可的动机，并评估了该团体为何在 3 年后允许认可失效。
作为一项更大的混合方法案例研究的一部分，我们对高管、临床医生和一线工作人员进行了 38 次重点知情人访谈。访谈是根据项目过程中不断发展的指南进行的，并进行了录音和完整转录。对转录本进行了分析和主题编码。
PCMH 原则与该组织的文化和使命一致，该组织重视创新和以患者为中心。实施特定 PCMH 组件的动机各不相同；有些组件被视为组织以患者为中心的文化的一部分，而其他组件则有助于实践在当地市场竞争。知情人一致报告说，由于当地一群大型雇主的一次性激励，以及由于该组织决定为其大约一半的诊所分配一些组织资源来应对复杂的报告要求，因此偶然获得了全国质量保证委员会的认可。
在这个组织中，以患者为中心和寻求认可作为一种方式是沿着不同但平行的轨道进行的。随着《平价医疗法案》继续关注初级保健的重新设计，应该记住这种明显的脱节。
