农村医疗诊所管理者加入 accountable care organizations 的意愿的预测因素。 （注：Accountable Care Organizations 可译为“责任医疗组织”，但原文未翻译，直接保留英文更合适，因为这是一个特定的专业术语，在医疗领域可能常用英文表述。）
Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations.
作者信息
T H Wan Thomas, Masri Maysoun Dimachkie, Ortiz Judith
机构信息
College of Health and Public Affairs, University of Central Florida, HPA 1, Room219, P.O. Box 163680, Orlando, Florida 32816-3680.
Department of Health Management and Informatics, College of Health and Public Affairs University of Central Florida, P.O. Box 163680, Orlando, Florida 32816-3680.
出版信息
Res Sociol Health Care. 2014;32:259-273. doi: 10.1108/S0275-495920140000032023.
PURPOSE
The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective.
METHODOLOGY/APPROACH: A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures - 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received.
FINDINGS
RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis.
RESEARCH LIMITATIONS/IMPLICATIONS: The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act.
ORIGINALITY/VALUE OF PAPER: Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.
目的
《患者保护与平价医疗法案》的实施推动了创新型综合医疗服务体系—— accountable care organizations（ACO，可问责医疗组织）的发展。现在是时候确定农村健康诊所的医疗管理者如何应对ACO模式了。本研究从组织生态学角度考察农村健康诊所管理者对实施ACO的感知利益和障碍。
方法/途径：2012年春季进行了一项调查，涵盖当前农村健康诊所网络的工作基础设施——1）组织社交网络；2）组织医疗服务提供结构；3）ACO知识、感知利益和感知障碍；4）质量和疾病管理项目；5）健康信息技术（HIT）基础设施。在美国对1160家诊所进行了调查。它们覆盖了八个东南部州（阿拉巴马州、佛罗里达州、佐治亚州、肯塔基州、密西西比州、北卡罗来纳州、南卡罗来纳州和田纳西州）以及加利福尼亚州。共收到91份回复。
研究结果
农村健康诊所管理者对ACO利益的个人认知和知识水平在其加入ACO的意愿方面解释了最大的差异。在预测分析中，个人认知似乎比组织和背景因素更具影响力。
研究局限/启示：该研究主要集中在美国东南部地区。其普遍性仅限于该地区。农村健康诊所参与ACO的预测因素有助于指导制定组织战略，以增强关于提供协调医疗服务的创新性和控制受《平价医疗法案》启发的医疗成本的一般知识。
论文的原创性/价值：农村健康诊所在采用ACO方面落后于增长曲线。传播关于ACO利弊的新知识对于加强美国的医疗改革至关重要。
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