Goldman Roberta E, Parker Donna R, Brown Joanna, Walker Judith, Eaton Charles B, Borkan Jeffrey M
Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Ann Fam Med. 2015 Mar;13(2):168-75. doi: 10.1370/afm.1765.
There is a strong push in the United States to evaluate whether the patient-centered medical home (PCMH) model produces desired results. The explanatory and contextually based questions of how and why PCMH succeeds in different practice settings are often neglected. We report the development of a comprehensive, mixed qualitative-quantitative evaluation set for researchers, policy makers, and clinician groups.
To develop an evaluation set, the Brown Primary Care Transformation Initiative convened a multidisciplinary group of PCMH experts, reviewed the PCMH literature and evaluation strategies, developed key domains for evaluation, and selected or created methods and measures for inclusion.
The measures and methods in the evaluation set (survey instruments, PCMH meta-measures, patient outcomes, quality measures, qualitative interviews, participant observation, and process evaluation) are meant to be used together. PCMH evaluation must be sufficiently comprehensive to assess and explain both the context of transformation in different primary care practices and the experiences of diverse stakeholders. In addition to commonly assessed patient outcomes, quality, and cost, it is critical to include PCMH components integral to practice culture transformation: patient and family centeredness, authentic patient activation, mutual trust among practice employees and patients, and transparency, joy, and collaboration in delivering and receiving care in a changing environment.
This evaluation set offers a comprehensive methodology to enable understanding of how PCMH transformation occurs in different practice settings. This approach can foster insights about how transformation affects critical outcomes to achieve meaningful, patient-centered, high-quality, and cost-effective sustainable change among diverse primary care practices.
美国正在大力推动评估以患者为中心的医疗之家（PCMH）模式是否能产生预期效果。然而，关于PCMH在不同实践环境中如何取得成功以及为何成功的解释性和基于背景的问题常常被忽视。我们报告了一套针对研究人员、政策制定者和临床医生群体的全面的定性 - 定量混合评估方法的开发情况。
为了开发一套评估方法，布朗初级医疗转型倡议召集了一个由PCMH专家组成的多学科小组，回顾了PCMH相关文献和评估策略，确定了关键评估领域，并选择或创建了纳入的方法和指标。
评估方法中的各项措施和方法（调查工具、PCMH综合指标、患者结局、质量指标、定性访谈、参与观察和过程评估）应协同使用。PCMH评估必须足够全面，以评估和解释不同初级医疗实践中的转型背景以及不同利益相关者的经历。除了通常评估的患者结局、质量和成本外，纳入对实践文化转型至关重要的PCMH组成部分也很关键：以患者和家庭为中心、真正的患者参与、实践机构员工与患者之间的相互信任，以及在不断变化环境中提供和接受护理时的透明度、愉悦感和协作。
这套评估方法提供了一种全面的方法，有助于理解PCMH转型在不同实践环境中是如何发生的。这种方法可以促进对转型如何影响关键结局的深入了解，从而在不同的初级医疗实践中实现有意义的、以患者为中心的、高质量且具有成本效益的可持续变革。
