Johnson Victoria, Wong Edwin, Lampman Michelle, Curtis Idamay, Fortney John, Kaboli Peter, Fihn Stephan, Nelson Karin
Washington Permanente Medical Group, Seattle (Dr Johnson); Division of General Internal Medicine (Drs Fihn and Nelson) and Department of Health Services (Drs Wong and Fortney), University of Washington, Seattle; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington (Drs Wong, Fortney, and Nelson); VHA Clinical Systems Development and Evaluation, Seattle, Washington (Dr Fihn and Ms Curtis); Center for Comprehensive Access and Delivery Evaluation at the Iowa City VA Health Care System, and Division of General Internal Medicine, University of Iowa, Iowa City (Dr Kaboli); and VISN 23 PACT Demonstration Lab, Iowa City and Mayo Clinic, Rochester MN (Dr Lampman).
J Ambul Care Manage. 2018 Jan/Mar;41(1):47-57. doi: 10.1097/JAC.0000000000000212.
Rural Veterans Health Administration (VHA) primary care clinics are smaller, have fewer staff, and serve more rural patients compared with urban VHA primary care clinics. This may lead to different challenges to implementation of the Patient-Centered Medical Home (PCMH) model, the Patient Aligned Care Team, in the VHAs' large integrated health system. In this cross-sectional observational study of 905 VHA primary clinics in the United States and Puerto Rico, we found overall PCMH implementation was greater in rural compared to urban primary care clinics. Urban-rural differences in PCMH implementation may largely be related to clinic organizational factors.
与城市退伍军人健康管理局（VHA）基层医疗诊所相比，农村VHA基层医疗诊所规模更小、工作人员更少，服务的农村患者更多。这可能给VHA大型综合医疗系统中以患者为中心的医疗之家（PCMH）模式（即患者协作医疗团队）的实施带来不同挑战。在这项针对美国和波多黎各905家VHA基层诊所的横断面观察性研究中，我们发现，与城市基层医疗诊所相比，农村地区PCMH的整体实施情况更好。PCMH实施方面的城乡差异可能在很大程度上与诊所组织因素有关。
