Miller-Day Michelle, Applequist Janelle, Zabokrtsky Keri, Dalton Alexandra, Kellom Katherine, Gabbay Robert, Cronholm Peter F
Department of Health and Strategic Communication, Chapman University , Orange, California, USA.
The Zimmerman School of Advertising, University of South Florida , Tampa, Florida, USA.
J Health Organ Manag. 2017 Sep 18;31(6):630-646. doi: 10.1108/JHOM-01-2017-0015.
Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction. Findings Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion. Originality/value Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.
目的 以患者为中心的医疗之家（PCMH）已成为初级医疗重新设计的主导模式。这种转变给许多医疗服务组织带来了挑战。本文的目的是描述四个医疗实践组中成功和不成功的实践转变所具有的特征。
设计/方法/途径 作为对25个向PCMH转变的实践进行的一项更大规模研究的一部分，当前研究聚焦于糖尿病护理，并根据糖化血红蛋白的定量患者指标以及实践绩效的定性评估，确定了高改善度和低改善度的医疗实践。从排名前两位的高改善度实践和排名后两位的低改善度实践中选取了一个子集作为比较组。对这些实践中的不同人员进行了半结构化访谈，以调查他们在实践转变方面的经历，并使用分析归纳法对数据进行了分析。
发现 结果显示了多种有助于更成功地进行PCMH转变的关键属性，例如确定患者名单、共享目标和定期会议，以及对PCMH转变的目的、目标和益处有清晰的理解，提供护理/病例管理服务，以及便利患者提醒。成功转变也存在一些障碍，例如用于应对财务支出的资源水平较低，对PCMH转变的目的、目标和益处缺乏理解，技术培训和管理不足，以及团队凝聚力较低。
原创性/价值 很少有研究对高绩效和低绩效实践进行定性比较和对比，以阐明实践转变的经历。这些发现突出了组织成员在实践转变中的经历及其面临的挑战，同时提供了高质量的糖尿病护理。
