DePuccio Matthew J, Hoff Timothy J
Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia (Mr DePuccio); and Northeastern University, D'Amore-McKim School of Business and School of Public Policy and Urban Affairs, Boston, Massachusetts (Dr Hoff).
Qual Manag Health Care. 2014 Oct-Dec;23(4):226-39. doi: 10.1097/QMH.0000000000000041.
Medical home care has been identified as a model for improving primary care delivery and population-specific quality and safety outcomes. Questions remain how this model affects older adult quality. This systematic review addresses 2 important questions: Are quality and safety outcomes associated with medical home and patient-centered interventions, and how is quality studied in older adult primary care research?
The authors searched MEDLINE for articles that examined interventions that were associated with medical home principles. Each article was evaluated using a standardized data abstraction form. Studies were categorized according to how interventions influenced specific quality and safety outcomes-improved clinical and treatment measures and care delivery processes-for older adults.
Thirteen research studies were identified by the authors. A great deal of variety exists in both research design and how quality and safety outcomes for older adults are operationalized in primary care. In general, studies indicate potentially beneficial relationships between 3 types of medical home interventions targeting health care utilization, disease management, and patient-provider communication to improved quality outcomes.
It would be advantageous for practices looking to align with patient-centered medical home quality and safety goals to consider the needs of older adults when redesigning care delivery.
医疗居家护理已被视为改善初级医疗服务以及特定人群质量与安全结果的一种模式。但该模式如何影响老年人的质量仍存在疑问。本系统评价解决两个重要问题：与医疗居家及以患者为中心的干预措施相关的质量与安全结果如何，以及在老年初级医疗研究中质量是如何被研究的？
作者在MEDLINE中检索了研究与医疗居家原则相关干预措施的文章。每篇文章均使用标准化的数据提取表进行评估。研究根据干预措施如何影响老年人的特定质量与安全结果（改善临床和治疗措施以及护理提供流程）进行分类。
作者共识别出13项研究。在研究设计以及初级医疗中如何将老年人的质量与安全结果进行操作化处理方面存在很大差异。总体而言，研究表明针对医疗保健利用、疾病管理以及医患沟通的3类医疗居家干预措施与改善质量结果之间可能存在有益关系。
对于希望与以患者为中心的医疗居家质量和安全目标保持一致的医疗机构而言，在重新设计护理服务时考虑老年人的需求将是有益的。
