Coulourides Kogan Alexis, Sadamitsu Kelly, Gaddini Michael, Kersten Michael, Ellinwood Jeanine, Fields Torrie
Department of Family Medicine and Geriatrics, Keck School of Medicine of USC, University of Southern California, Alhambra, California, USA.
Snowline, Sacramento, California, USA.
Palliat Med Rep. 2020 Nov 5;1(1):259-263. doi: 10.1089/pmr.2020.0009. eCollection 2020.
Before the Affordable Care Act (ACA), the financing landscape for fee-for-service health care lacked broad structure and incentives to provide palliative care outside hospitals. Since the ACA, several payers have taken the opportunity to offer home-based palliative care (HBPC) to their members. To evaluate the impact of outreach efforts by a physician champion among a cohort of primary care physicians (PCPs) to introduce a new HBPC program and benefit, obtain buy-in, and motivate referrals for Blue Shield patients. Secondary qualitative analysis of detailed field notes from a HBPC physician champion from in-person meetings with a cohort of PCPs and their office staff. PCPs were from a physicians group in northern California that met with the physician champion during a 12-month study period. During the 12-month study period, the physician champion met with clinicians at 27 distinct primary care offices. Qualitative analyses revealed three independent themes relating to receptivity and perception of the new HBPC program: (1) physician-level factors (overburdened, lack of palliative care knowledge, misconceptions around palliative care, and patient control), (2) practice-level factors (practice structure and role/integration of advance practice providers), and (3) first impression of the HBPC program (receptivity, "dirty data," and communication). Results hold important implications for practice and new approaches to engaging PCPs in HBPC, obtaining buy-in, and generating patient referrals. PCPs need better support in caring for patients with serious illness and HBPC can likely fill that role if PCPs are willing to refer and HBPC programs adapt.
在《平价医疗法案》（ACA）出台之前，按服务收费的医疗保健融资格局缺乏广泛的结构，也缺乏在医院外提供姑息治疗的激励措施。自《平价医疗法案》实施以来，一些支付方抓住机会为其成员提供居家姑息治疗（HBPC）。为评估一位医师倡导者在一群初级保健医生（PCP）中开展外展工作的影响，该外展工作旨在引入一项新的HBPC项目并带来益处、获得认可并促使为蓝盾患者进行转诊。对一位HBPC医师倡导者与一群PCP及其办公室工作人员进行面对面会议后所做的详细现场记录进行二次定性分析。PCP来自加利福尼亚州北部的一个医师团体，在为期12个月的研究期间与该医师倡导者会面。在这12个月的研究期间，该医师倡导者在27个不同的初级保健办公室与临床医生会面。定性分析揭示了与对新HBPC项目的接受度和认知相关的三个独立主题：（1）医师层面的因素（负担过重、缺乏姑息治疗知识、对姑息治疗的误解以及患者控制权），（2）实践层面的因素（实践结构以及高级实践提供者的角色/整合情况），以及（3）对HBPC项目的第一印象（接受度、“脏数据”和沟通）。研究结果对实践以及让PCP参与HBPC、获得认可并促成患者转诊的新方法具有重要意义。在照顾重症患者方面，PCP需要更好的支持，如果PCP愿意转诊且HBPC项目能够做出调整，那么HBPC很可能可以发挥这一作用。
