The Medical University of South Carolina, Charleston, South Carolina, USA.
The Pennsylvania State University, University Park, Pennsylvania, USA.
Health Serv Res. 2020 Dec;55 Suppl 3(Suppl 3):1144-1154. doi: 10.1111/1475-6773.13576.
To understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work.
A purposive sample of 24 health systems in 4 states.
Data were systematically reviewed to identify how system leaders define and implement initiatives to redesign primary care delivery and identify challenges. Researchers applied codes which were based on the theoretical PCR literature and created new codes to capture emerging themes. Investigators analyzed coded data then produced and applied a thematic analysis to examine how health systems facilitate PCR.
Semi-structured telephone interviews with 162 system executives and physician organization leaders from 24 systems.
Leaders at all 24 health systems described initiatives to redesign the delivery of primary care, but many were in the early stages. Respondents described the use of centralized health system resources to facilitate PCR initiatives, such as regionalized care coordinators, and integrated electronic health records. Team-based care, population management, and care coordination were the most commonly described initiatives to transform primary care delivery. Respondents most often cited improving efficiency and enhancing clinician job satisfaction, as motivating factors for team-based care. Changes in payment and risk assumption as well as community needs were commonly cited motivators for population health management and care coordination. Return on investment and the slower than anticipated rate in moving from fee-for-service to value-based payment were noted by multiple respondents as challenges health systems face in redesigning primary care.
Given their expanding role in health care and the potential to leverage resources, health systems are promising entities to promote the advancement of PCR. Systems demonstrate interest and engagement in this work but face significant challenges in getting to scale until payment models are in alignment with these efforts.
了解卫生系统如何促进基层医疗服务重新设计（PCR），考察系统内正在进行的 PCR 计划，并确定这方面工作的障碍。
4 个州的 24 个卫生系统的随机样本。
系统地审查数据，以确定系统领导者如何定义和实施重新设计基层医疗服务的计划，并确定挑战。研究人员根据理论上的 PCR 文献应用了代码，并创建了新的代码来捕捉新出现的主题。调查人员分析了编码数据，然后生成并应用了主题分析，以研究卫生系统如何促进 PCR。
对来自 24 个系统的 162 名系统主管和医生组织领导人进行了半结构式电话访谈。
所有 24 个卫生系统的领导人都描述了重新设计基层医疗服务提供的计划，但许多计划仍处于早期阶段。受访者描述了利用集中的卫生系统资源来促进 PCR 计划，例如区域化的护理协调员和综合电子健康记录。团队为基础的护理、人口管理和护理协调是最常描述的转变基层医疗服务提供的计划。受访者最常提到提高效率和提高临床医生的工作满意度作为团队为基础的护理的激励因素。改变支付和风险承担以及社区需求是人口健康管理和护理协调的常见激励因素。多位受访者指出，在重新设计基层医疗方面，投资回报和从按服务收费向基于价值的支付转变的速度较慢是卫生系统面临的挑战。
鉴于他们在医疗保健中的扩大作用以及利用资源的潜力，卫生系统是促进 PCR 发展的有希望的实体。系统对这项工作表现出兴趣和参与，但在支付模式与这些努力保持一致之前，在扩大规模方面面临重大挑战。
