Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
Ethn Dis. 2013 Summer;23(3):356-62.
Safety net health centers (SNHCs), which include federally qualified health centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the patient centered medical home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs.
This qualitative study characterizes early PCMH adoption experiences at SNHCs.
We interviewed 98 staff (administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative.
We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH.
Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback.
SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved health care delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation.
安全网健康中心（SNHCs）包括合格的联邦健康中心（FQHCs），为服务不足、少数民族和低收入患者提供初级护理。全国范围内的 SNHCs 正在采用以患者为中心的医疗之家（PCMH）模式，这是基于早期示范项目的有希望的实施数据。然而，以前的示范项目并没有关注安全网，我们对 SNHCs 中的 PCMH 转型知之甚少。
这项定性研究描绘了 SNHCs 早期采用 PCMH 的经验。
我们采访了来自五个州的 65 个 SNHC 中的 20 个的 98 名工作人员（管理人员、提供者和临床工作人员），他们正在参与为期五年的 PCMH 合作项目的第一年，即安全网医疗之家倡议。
我们进行了 30-45 分钟的半结构化电话采访。采访问题涉及预期的收益、遇到的障碍以及在向 PCMH 过渡中学到的经验。
参与 PCMH 的预期收益包括提高员工满意度和患者护理和结果。障碍包括员工抵制和缺乏 PCMH 功能的财务支持。经验教训包括涉及各种员工、预期抵制以及使用数据作为频繁反馈。
SNHCs 在实施 PCMH 方面面临着独特的挑战，包括员工流动和为有复杂需求的患者提供护理。通过与 PCMH 相关的改善医疗服务提供策略，可以减轻员工抵制和流动的问题。创建可预测和持续的资金流可能是 PCMH 转型更根本的挑战。
