退伍军人健康管理局的以患者为中心的医疗之家。

The patient-centered medical home in the Veterans Health Administration.

机构信息

VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.

出版信息

Am J Manag Care. 2013 Jul 1;19(7):e263-72.

PMID:23919446

Abstract

BACKGROUND

The Veterans Health Administration (VHA) is the largest integrated US health system to implement the patient-centered medical home. The Patient Aligned Care Team (PACT) initiative (implemented 2010-2014) aims to achieve team based care, improved access, and care management for more than 5 million primary care patients nationwide.

OBJECTIVES

To describe PACT and evaluate interim changes in PACT-related care processes.

STUDY DESIGN

Data from the VHA Corporate Data Warehouse were obtained from April 2009 (pre- PACT) to September 2012. All patients assigned to a primary care provider (PCP) at all VHA facilities were included.

METHODS

Nonparametric tests of trend across time points.

RESULTS

VHA increased primary care staff levels from April 2010 to December 2011 (2.3 to 3.0 staff per PCP full-time equivalent). In-person PCP visit rates slightly decreased from April 2009 to April 2012 (53 to 43 per 100 patients per calendar quarter; P < .01), while in-person nurse encounter rates remained steady. Large increases were seen in phone encounters (2.7 to 28.8 per 100 patients per quarter; P < .01), enhanced personal health record use (3% to 13% of patients enrolled), and electronic messaging to providers (0.01% to 2.3% of patients per quarter). Post hospitalization follow-up improved (6.6% to 61% of VA hospital discharges), but home telemonitoring (0.8% to 1.4% of patients) and group visits (0.2 to 0.65 per 100 patients per quarter; P < .01) grew slowly.

CONCLUSIONS

Thirty months into PACT, primary care staff levels and phone and electronic encounters have greatly increased; other changes have been positive but slower.

摘要

背景

退伍军人健康管理局（VHA）是美国最大的综合性医疗体系，率先实施以患者为中心的医疗之家。患者一致护理团队（PACT）计划（2010-2014 年实施）旨在为全国 500 多万名初级保健患者实现团队护理、改善就诊机会和护理管理。

目的

描述 PACT 并评估 PACT 相关护理流程的中期变化。

研究设计

从 2009 年 4 月（PACT 前）到 2012 年 9 月，从 VHA 企业数据仓库获取数据。所有分配给 VHA 所有设施初级保健医生（PCP）的患者均纳入研究。

方法

非参数趋势检验。

结果

VHA 从 2010 年 4 月至 2011 年 12 月增加了初级保健人员配备（每 1 名 PCP 全职当量增加 2.3 至 3.0 名员工）。2009 年 4 月至 2012 年 4 月，面对面 PCP 就诊率略有下降（每 100 名患者每季度就诊率从 53 次降至 43 次；P <.01），而护士面对面接触率保持稳定。电话咨询大幅增加（每季度每 100 名患者从 2.7 次增至 28.8 次；P <.01），个人健康记录使用率提高（注册患者的 3%增至 13%），向医生发送电子信息的比例提高（每季度每位患者的 0.01%增至 2.3%）。住院后随访情况改善（退伍军人事务部出院患者的 6.6%增至 61%），但家庭远程监护（患者的 0.8%增至 1.4%）和小组访问（每季度每 100 名患者的 0.2 次至 0.65 次；P <.01）的增长速度较慢。