Block Lauren, LaVine Nancy, Verbsky Jennifer, Sagar Ankita, Smith Miriam A, Lane Susan, Conigliaro Joseph, Chaudhry Saima A
a Department of Medicine , Northwell Health , Lake Success , NY , USA.
b Department of Medicine , Stony Brook University Medical Center , Stony Brook , NY , USA.
Med Educ Online. 2017;22(1):1352434. doi: 10.1080/10872981.2017.1352434.
Increasingly, residents are being trained in Patient-centered Medical Home (PCMH) settings. A set of PCMH entrustable professional activities (EPAs) for residents has been defined but not evaluated in practice.
To understand whether residents trained at PCMH sites reported higher likelihood of engaging in PCMH tasks than those training in non-PCMH sites.
Survey and nominal group data from post-graduate trainees at three residency programs.
A total of 179 residents responded (80% response). Over half (52%) cared for patients at PCMH sites. Residents at PCMH sites were more likely to report engaging in tasks in the NCQA domains of enhancing access and continuity (p < 0.01 for 4/11 tasks), planning and managing care (p < 0.01 for 3/4 tasks), providing self-care and community support (p < 0.01 for 3/5 tasks), and identifying and managing patient populations (p < 0.01 for 1/6 tasks), but were not more likely to report tracking and coordinating care or measuring and improving performance. Residents at PCMH sites were more likely to report working with medical assistants (p < 0.01), but not other healthcare professionals. Qualitative data showed staff teamwork and continuity of care as facilitators of patient-centered care, and technological problems and office inefficiencies as barriers to care.
Residents trained at PCMH sites were more likely to engage in tasks in several NCQA domains, but not care coordination and quality assessment. Similar facilitators and barriers to trainee provision of patient-centered care were cited regardless of PCMH status. Curricula on PCMH principles and workflows that foster continuity and communication may help to inform residents on PCMH tenets and incorporate residents into team-based care.
EPA: Entrustable professional activity; GIM: General Internal Medicine; NCQA: National Center for Quality Assurance; PCMH: Patient-centered medical home.
越来越多的住院医师在以患者为中心的医疗之家（PCMH）环境中接受培训。已定义了一套针对住院医师的PCMH可托付专业活动（EPA），但尚未在实践中进行评估。
了解在PCMH机构接受培训的住院医师是否比在非PCMH机构培训的住院医师更有可能参与PCMH任务。
来自三个住院医师培训项目的研究生学员的调查和名义组数据。
共有179名住院医师回复（回复率80%）。超过一半（52%）的人在PCMH机构照顾患者。PCMH机构的住院医师更有可能报告参与了美国国家质量保证中心（NCQA）提高可及性和连续性领域的任务（11项任务中的4项，p<0.01）、规划和管理护理领域的任务（4项任务中的3项，p<0.01）、提供自我护理和社区支持领域的任务（5项任务中的3项，p<0.01）以及识别和管理患者群体领域的任务（6项任务中的1项，p<0.01），但报告跟踪和协调护理或衡量和改善绩效的可能性并不更高。PCMH机构的住院医师更有可能报告与医疗助理合作（p<0.01），但与其他医疗保健专业人员合作的可能性并非更高。定性数据显示，员工团队合作和护理连续性是患者为中心护理的促进因素，技术问题和办公室效率低下是护理的障碍。
在PCMH机构接受培训的住院医师更有可能参与NCQA几个领域的任务，但不包括护理协调和质量评估。无论PCMH状态如何，学员提供以患者为中心护理时都存在类似的促进因素和障碍。关于促进连续性和沟通的PCMH原则和工作流程的课程可能有助于让住院医师了解PCMH原则，并将住院医师纳入团队护理。
EPA：可托付专业活动；GIM：普通内科；NCQA：美国国家质量保证中心；PCMH：以患者为中心的医疗之家
