Jortberg Bonnie T, Fernald Douglas H, Dickinson L Miriam, Coombs Letoynia, Deaner Nicole, O'Neill Caitlin, deGruy Frank, Green Larry, Dickinson W Perry
Department of Family Medicine, University of Colorado.
Fam Med. 2014 Jan;46(1):11-8.
The patient-centered medical home (PCMH) is a practice model that is intended to improve the quality of care by making it safer, more comprehensive, integrated, and personal. However, most family medicine residency programs are not fully prepared to train residents on this idealized model. The Colorado Family Medicine Residency PCMH Project's overall objective is to transform 10 residency practices into PCMHs through practice improvement and curriculum redesign. This paper focuses on the programs' implementation of key PCMH components into the residency curricula and the impact on resident self-perceived competence in and use of PCMH components.
Mixed-method evaluation assessed PCMH curricular characteristics, routine use of PCMH components in patient care, and perceived resident competence after implementation of quality improvement coaching and PCMH curriculum tools. Baseline and follow-up PCMH semi-structured curriculum interviews assessed elements included in the residency programs' curricula. The PCMH Clinician Assessment (PCMH-CA) Survey assessed routine use of PCMH components in patient care. The PCMH Competency Self-Assessment Survey assessed residents' perceived competency in applying PCMH elements in patient care.
Qualitative data results demonstrated active efforts by the residency programs to implement key PCMH components. Survey results showed significant improvement from baseline to follow-up (12--36 months).
Implementation of the key components of PCMH into practice improvement efforts and residency curricula improved residents' routine use of PCMH in patient care and their perceived PCMH competence.
以患者为中心的医疗之家(PCMH)是一种旨在通过使其更安全、更全面、更具整合性和个性化来提高医疗质量的实践模式。然而,大多数家庭医学住院医师培训项目并未充分准备好按照这种理想化模式对住院医师进行培训。科罗拉多家庭医学住院医师PCMH项目的总体目标是通过实践改进和课程重新设计,将10个住院医师培训实践转变为PCMH。本文重点关注这些项目将PCMH关键组成部分纳入住院医师培训课程的实施情况,以及对住院医师在PCMH组成部分方面自我感知能力和使用情况的影响。
采用混合方法评估PCMH课程特点、PCMH组成部分在患者护理中的常规使用情况,以及在实施质量改进指导和PCMH课程工具后住院医师的感知能力。基线和随访时的PCMH半结构化课程访谈评估住院医师培训课程中包含的要素。PCMH临床医生评估(PCMH-CA)调查评估PCMH组成部分在患者护理中的常规使用情况。PCMH能力自我评估调查评估住院医师在患者护理中应用PCMH要素的感知能力。
定性数据结果表明住院医师培训项目积极努力实施PCMH关键组成部分。调查结果显示从基线到随访(12 - 36个月)有显著改善。
将PCMH关键组成部分纳入实践改进工作和住院医师培训课程,改善了住院医师在患者护理中对PCMH的常规使用及其对PCMH能力的感知。