Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1421, Los Angeles, CA, 90015, USA.
Health Services Research & Implementation Science, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
J Gen Intern Med. 2019 Jun;34(6):1032-1038. doi: 10.1007/s11606-018-4818-7. Epub 2019 Jan 8.
Despite policy and practice support to develop and test interventions designed to increase access to quality care among high-need patients, many of these interventions fail to meet expectations once deployed in real-life clinical settings. One example is the Patient-Centered Medical Home (PCMH) model, designed to deliver coordinated care. A meta-analysis of PCMH initiatives found mixed evidence of impacts on service access, quality, and costs. Conceptualizing PCMH as a complex health intervention can generate insights into the mechanisms by which this model achieves its effects. It can also address heterogeneity by distinguishing PCMH core functions (the intervention's basic purposes) from forms (the strategies used to meet each function). We conducted a scoping review to identify core functions and forms documented in published PCMH models from 2007 to 2017. We analyzed and summarized the data to develop a PCMH Function and Form Matrix. The matrix contributes to the development of an explicit theory-based depiction of how an intervention achieves its effects, and can guide decision-support tools in the field. This innovative approach can support transformations of clinical settings and implementation efforts by building on a clear understanding of the intervention's standard core functions and the forms adapted to local contexts' characteristics.
尽管政策和实践支持开发和测试旨在增加高需求患者获得优质护理的干预措施，但许多这些干预措施在实际临床环境中部署后并未达到预期效果。以提供协调护理为设计目的的以患者为中心的医疗之家（PCMH）模式就是一个例子。对 PCMH 计划的荟萃分析发现，其对服务可及性、质量和成本的影响存在混合证据。将 PCMH 概念化为一种复杂的健康干预措施可以深入了解该模式实现其效果的机制。它还可以通过区分 PCMH 的核心功能（干预的基本目的）和形式（用于满足每个功能的策略）来解决异质性问题。我们进行了范围审查，以确定 2007 年至 2017 年发表的 PCMH 模型中记录的核心功能和形式。我们对数据进行了分析和总结，以开发 PCMH 功能和形式矩阵。该矩阵有助于发展基于理论的明确描述，说明干预措施如何实现其效果，并可以为该领域的决策支持工具提供指导。这种创新方法可以通过对干预措施的标准核心功能和适应当地情况特征的形式有清晰的理解，为临床环境的转变和实施工作提供支持。
