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医疗协调中的医生参与策略:来自医疗保险和医疗补助服务中心医疗保健创新奖计划的发现

Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare & Medicaid Services' Health Care Innovation Awards Program.

作者信息

Skillman Megan, Cross-Barnet Caitlin, Singer Rachel Friedman, Ruiz Sarah, Rotondo Christina, Ahn Roy, Snyder Lynne Page, Colligan Erin M, Giuriceo Katherine, Moiduddin Adil

机构信息

NORC at the University of Chicago, Chicago, IL.

Center for Medicare & Medicaid Innovation, Baltimore, MD.

出版信息

Health Serv Res. 2017 Feb;52(1):291-312. doi: 10.1111/1475-6773.12622. Epub 2016 Dec 2.

Abstract

OBJECTIVE

To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs.

DATA SOURCES

Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations.

STUDY DESIGN

NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews.

DATA COLLECTION/EXTRACTION METHODS: We used qualitative thematic coding for data from 21 programs actively engaging physicians as part of HCIA interventions.

PRINCIPAL FINDINGS

Establishing physician champions and ensuring an innovation-values fit between physicians and programs, including the strategies programs employed, facilitated engagement. Among engagement practices identified in this study, tailoring team working styles to meet physician preferences and conducting physician outreach and education were the most common successful approaches.

CONCLUSIONS

We describe engagement strategies derived from a diverse range of programs. Successful programs considered physicians' values and engagement as components of process and policy, rather than viewing them as exogenous factors affecting innovation adoption. These types of approaches enabled programs to accelerate acceptance of innovations within organizations.

摘要

目的

确定医生在新的医疗服务模式中所扮演的角色,以及在21个医疗保健创新奖(HCIA)项目中促进医生参与的相关策略。

数据来源

2014年至2015年对项目工作人员、领导层和合作伙伴(包括95名医生)进行的现场深度访谈(N = 672)以及直接观察。

研究设计

美国国家民意研究中心(NORC)进行了一项混合方法评估,包括通过实地考察和电话访谈收集两轮定性数据。

数据收集/提取方法:我们对来自21个积极让医生参与作为HCIA干预措施一部分的项目的数据进行了定性主题编码。

主要发现

设立医生倡导者,并确保医生与项目之间在创新价值观上相契合,包括项目采用的策略,促进了医生的参与。在本研究中确定的参与实践中,根据医生的偏好调整团队工作方式以及开展医生宣传和教育是最常见的成功方法。

结论

我们描述了从各种项目中得出的参与策略。成功的项目将医生的价值观和参与视为流程和政策的组成部分,而不是将其视为影响创新采用的外部因素。这些类型的方法使项目能够加速组织内对创新的接受。

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