Dr. Bitton is associate physician and assistant professor of medicine, Division of General Medicine, Brigham and Women's Hospital, and faculty lead for transformation strategy and design, Center for Primary Care, Harvard Medical School, Boston, Massachusetts. Dr. Ellner is associate physician and assistant professor of medicine, Division of Global Health Equity, Brigham and Women's Hospital, and codirector, Center for Primary Care, Harvard Medical School, Boston, Massachusetts. Dr. Pabo is a postgraduate year 3 resident, Brigham and Women's Hospital, and clinical fellow in medicine, Harvard Medical School, Boston, Massachusetts. Dr. Stout is vice president of patient centered medical home development, Cambridge Health Alliance, instructor in medicine, and director, Academic Innovations Collaborative Leadership Academy, Center for Primary Care, Harvard Medical School, Boston, Massachusetts. Dr. Sugarman is president and CEO, Qualis Health and Clinical Professor, Departments of Family Medicine and Epidemiology, University of Washington, Seattle, Washington. Ms. Sevin is director, Institute for Healthcare Improvement, Cambridge, Massachusetts. Dr. Goodell is director, Innovation in Medical Education, and clinical instructor, Population Medicine, Center for Primary Care, Harvard Medical School, Boston, Massachusetts. Ms. Bassett is executive director, Center for Primary Care, Harvard Medical School, Boston, Massachusetts. Dr. Phillips is director, Center for Primary Care, and William S. Applebaum Professor of Medicine and Professor of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
Acad Med. 2014 Sep;89(9):1239-44. doi: 10.1097/ACM.0000000000000410.
Academic medical centers (AMCs) need new approaches to delivering higher-quality care at lower costs, and engaging trainees in the work of high-functioning primary care practices.
In 2012, the Harvard Medical School Center for Primary Care, in partnership with with local AMCs, established an Academic Innovations Collaborative (AIC) with the goal of transforming primary care education and practice. This novel two-year learning collaborative consisted of hospital- and community-based primary care teaching practices, committed to building highly functional teams, managing populations, and engaging patients. The AIC built on models developed by Qualis Health and the Institute for Healthcare Improvement, optimized for the local AMC context. Foundational elements included leadership engagement and development, application of rapid-cycle process improvement, and the creation of teams to care for defined patient populations. Nineteen practices across six AMCs participated, with nearly 260,000 patients and 450 resident learners. The collaborative offered three 1.5-day learning sessions each year featuring shared learning, practice coaches, and improvement measures, along with monthly data reporting, webinars, and site visits.
Validated self-reports by transformation teams showed that practices made substantial improvement across all areas of change. Important factors for success included leadership development, practice-level resources, and engaging patients and trainees.
The AIC model shows promise as a path for AMCs to catalyze health system transformation through primary care improvement. In addition to further evaluating the impact of practice transformation, expansion will require support from AMCs and payers, and the application of similar approaches on a broader scale.
学术医学中心（AMC）需要新的方法来以更低的成本提供更高质量的护理，并让学员参与高功能初级保健实践的工作。
2012 年，哈佛医学院基础医疗中心与当地 AMC 合作，成立了学术创新协作组织（AIC），旨在转变初级保健教育和实践。这是一个新颖的为期两年的学习协作组织，由医院和社区基础医疗教学实践组成，致力于建立高功能团队、管理人群并让患者参与其中。AIC 借鉴了 Qualis Health 和 Institute for Healthcare Improvement 开发的模型，并针对当地 AMC 环境进行了优化。基本要素包括领导力参与和发展、快速循环流程改进的应用，以及为特定患者群体提供护理的团队建设。六家 AMC 的 19 个实践参与其中，拥有近 26 万名患者和 450 名住院医师学员。协作组织每年提供三次为期 1.5 天的学习课程，包括共享学习、实践教练和改进措施，以及每月的数据报告、网络研讨会和现场访问。
转型团队的有效自我报告显示，实践在所有变革领域都取得了实质性的改进。成功的重要因素包括领导力发展、实践层面的资源，以及患者和学员的参与。
AIC 模式为 AMC 通过初级保健改善来推动医疗系统转型提供了希望。除了进一步评估实践转型的影响外，还需要 AMC 和支付方的支持，以及更广泛地应用类似方法。
