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Am J Manag Care. 2021 Sep;27(9):386-393. doi: 10.37765/ajmc.2021.88740.
Knowing which patient-centered medical home (PCMH) care delivery changes and quality improvement (QI) practices further PCMH implementation is essential.
We used the 2008-2017 National Committee of Quality Assurance (NCQA) PCMH directory of 15,188 primary care practices that received Level 1, 2, or 3 NCQA PCMH recognition to construct a stratified national sample of 105 practices engaged in PCMH transformation. We examined their QI practices and PCMH changes associated with PCMH transformation.
We derived QI practice and PCMH change variables from semistructured interviews. Practice leaders completed the PCMH Assessment (PCMH-A) measuring the practice's degree of PCMH implementation, which is a proxy for patient-centeredness. Controlling for practice characteristics, we regressed PCMH-A scores on QI practice and PCMH change variables.
Practices undergoing PCMH transformation nationwide most commonly made care delivery changes in access and continuity of care. To improve quality, practices most commonly engaged in discussing and targeting areas of patient experience improvement, trending performance, and conducting targeted QI. However, practices lower in patient-centeredness as measured by the PCMH-A were more likely to engage in efforts to improve patient experiences, such as reviewing patient experience data or engaging in 1-on-1 provider counseling related to patient interactions. Mature PCMH practices focused on changes in continuity of care.
Practices undertake a wide variety of care delivery changes and QI practices simultaneously to meet PCMH requirements. The patient experience-specific QI practices and PCMH care delivery changes that practices make to improve patient-centeredness differ by years of PCMH recognition.
了解以患者为中心的医疗之家（PCMH）的哪些护理交付变更和质量改进（QI）实践能进一步推动 PCMH 的实施至关重要。
我们使用了 2008 年至 2017 年全国质量保证委员会（NCQA）的 15188 个初级保健实践的 PCMH 目录，这些实践获得了 NCQA PCMH 一级、二级或三级认可，构建了一个参与 PCMH 转型的 105 个实践的分层全国样本。我们检查了他们的 QI 实践和与 PCMH 转型相关的 PCMH 变化。
我们从半结构化访谈中得出了 QI 实践和 PCMH 变化变量。实践负责人完成了 PCMH 评估（PCMH-A），衡量实践的 PCMH 实施程度，这是患者为中心的代理。在控制实践特征的情况下，我们将 PCMH-A 评分与 QI 实践和 PCMH 变化变量进行回归。
全国范围内正在进行 PCMH 转型的实践最常见的护理交付变化是在获得和连续性护理方面。为了提高质量，实践最常见的做法是讨论和针对患者体验改善、趋势性能和进行有针对性的 QI 的领域。然而，PCMH-A 衡量的患者为中心程度较低的实践更有可能努力改善患者体验，例如审查患者体验数据或进行一对一的提供者咨询，以改善患者与提供者的互动。成熟的 PCMH 实践专注于连续性护理的变化。
实践同时进行广泛的护理交付变更和 QI 实践，以满足 PCMH 的要求。实践为提高以患者为中心而进行的特定于患者体验的 QI 实践和 PCMH 护理交付变更因 PCMH 认可的年限而异。
