Fernald Douglas, Hall Tristen, Montgomery Linda, Hartman Chandra, Jortberg Bonnie, Buscaj Emilie, King Jaclyn, Dickinson Miriam, Dickinson W Perry
University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO.
Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO.
Fam Med. 2019 Jul;51(7):578-586. doi: 10.22454/FamMed.2019.928558. Epub 2019 May 21.
Our objective was to describe the results of a 6-year patient-centered medical home (PCMH) transformation program in 11 Colorado primary care residency practices.
We used a parallel qualitative and quantitative evaluation including cross-sectional surveys of practice staff and clinicians, group and individual interviews, meeting notes, and longitudinal practice facilitator field notes. Survey analyses assessed change over time, adjusting for practice-level random effects. Qualitative data analysis used iterative template coding and matrix analyses to synthesize data over time and across cases.
There were significant improvements in clinicians' self-reported routine delivery of patient-centered care, team-based care, self-management support, and use of information systems (P<.0001). Clinicians and staff reported significant gains in practice change culture (P=.001). Self-reported practice-level assessments pointed to additional significant improvements in quality improvement (QI) processes, continuity of care, self-management support/care coordination, and the use of data and population management (P≤.0215). Practices and their practice facilitators reported important changes in how practices operated, significantly improving their QI processes, shared leadership, change culture, and achieving Level III PCMH NCQA Recognition. Important barriers to further progress remain, including inadequate payment models, inflexible staff roles, and difficult access to clinical data.
The success of these 11 primary care residency practices in making significant improvements in their delivery of patient-centered care, team-based care, self-management support, and use of information systems took time, effort, and external support. Further practice redesign for advanced primary care models will take sustained sources of well-aligned support, flexibility, shared leadership, and partnerships across residency programs for collaborative learning to assist in their transformation efforts.
我们的目标是描述科罗拉多州11家基层医疗住院医师培训实践机构中为期6年的以患者为中心的医疗之家（PCMH）转型项目的结果。
我们采用了定性与定量并行的评估方法，包括对实践机构工作人员和临床医生的横断面调查、小组和个人访谈、会议记录以及实践促进者的纵向现场记录。调查分析评估了随时间的变化，并对实践层面的随机效应进行了调整。定性数据分析采用迭代模板编码和矩阵分析，以综合不同时间和不同案例的数据。
临床医生自我报告的以患者为中心的常规医疗服务、团队医疗、自我管理支持以及信息系统的使用有显著改善（P<0.0001）。临床医生和工作人员报告称，实践变革文化有显著提升（P = 0.001）。自我报告的实践层面评估表明，质量改进（QI）流程、医疗连续性、自我管理支持/医疗协调以及数据和人群管理的使用有进一步显著改善（P≤0.0215）。实践机构及其实践促进者报告了实践运作方式的重要变化，显著改善了其QI流程、共享领导力、变革文化，并获得了PCMH NCQA三级认证。进一步推进仍存在重要障碍，包括支付模式不足、工作人员角色缺乏灵活性以及获取临床数据困难。
这11家基层医疗住院医师培训实践机构在以患者为中心的医疗服务、团队医疗、自我管理支持以及信息系统使用方面取得显著改善的成功，需要时间、努力和外部支持。进一步为高级基层医疗模式重新设计实践，将需要持续的、协调一致的支持来源、灵活性、共享领导力以及住院医师培训项目之间的伙伴关系，以促进协作学习，协助其转型努力。
Zotero 插件