Wang Jason J, Cha Jisung, Sebek Kimberly M, McCullough Colleen M, Parsons Amanda S, Singer Jesse, Shih Sarah C
Primary Care Information Project (PCIP), NYC DOHMH, Long Island City (Queens), NY.
Health Serv Res. 2014 Dec;49(6):1729-46. doi: 10.1111/1475-6773.12243. Epub 2014 Oct 6.
To analyze the impact of three primary care practice transformation program models on performance: Meaningful Use (MU), Patient-Centered Medical Home (PCMH), and a pay-for-performance program (eHearts).
DATA SOURCES/STUDY SETTING: Data for seven quality measures (QM) were retrospectively collected from 192 small primary care practices between October 2009 and October 2012; practice demographics and program participation status were extracted from in-house data.
Bivariate analyses were conducted to measure the impact of individual programs, and a Generalized Estimating Equation model was built to test the impact of each program alongside the others.
DATA COLLECTION/EXTRACTION METHODS: Monthly data were extracted via a structured query data network and were compared to program participation status, adjusting for variables including practice size and patient volume. Seven QMs were analyzed related to smoking prevention, blood pressure control, BMI, diabetes, and antithrombotic therapy.
In bivariate analysis, MU practices tended to perform better on process measures, PCMH practices on more complex process measures, and eHearts practices on measures for which they were incentivized; in multivariate analysis, PCMH recognition was associated with better performance on more QMs than any other program.
Results suggest each of the programs can positively impact performance. In our data, PCMH appears to have the most positive impact.
分析三种基层医疗实践转型项目模式对绩效的影响：有意义使用（MU）、以患者为中心的医疗之家（PCMH）以及按绩效付费项目（eHearts）。
数据来源/研究背景：2009年10月至2012年10月期间，从192家小型基层医疗实践中回顾性收集了七项质量指标（QM）的数据；实践人口统计学和项目参与状况从内部数据中提取。
进行双变量分析以衡量各个项目的影响，并建立广义估计方程模型来测试每个项目与其他项目一起时的影响。
数据收集/提取方法：通过结构化查询数据网络提取月度数据，并与项目参与状况进行比较，对包括实践规模和患者数量在内的变量进行调整。分析了与吸烟预防、血压控制、体重指数、糖尿病和抗血栓治疗相关的七项质量指标。
在双变量分析中，MU实践在过程指标上往往表现更好，PCMH实践在更复杂的过程指标上表现更好，eHearts实践在其受到激励的指标上表现更好；在多变量分析中，PCMH认证与比其他任何项目更多的质量指标上的更好表现相关。
结果表明每个项目都能对绩效产生积极影响。在我们的数据中，PCMH似乎产生的积极影响最大。
