The New York Academy of Medicine, New York, NY, USA.
New York State Department of Health, Albany, NY, USA.
J Prim Care Community Health. 2022 Jan-Dec;13:21501319221112588. doi: 10.1177/21501319221112588.
The patient-centered medical home (PCMH) model, an important component of healthcare transformation in the United States, is an approach to primary care delivery with the goal of improving population health and the patient care experience while reducing costs. PCMH research most often focuses on system level indicators including healthcare use and cost; descriptions of patient and provider experience with PCMH are relatively sparse and commonly limited in scope. This study, part of a mixed-methods evaluation of a multi-year New York State initiative to refine and expand the PCMH model, describes patient and provider experience with New York State PCMH and its key components.
The qualitative component of the evaluation included focus groups with patients of PCMH practices in 5 New York State counties (n = 9 groups and 67 participants) and interviews with providers and practice administrators at New York State PCMH practices (n = 9 interviews with 10 participants). Through these focus groups and interviews, we elicited first-person descriptions of experiences with, as well as perspectives on, key components of the New York State PCMH model, including accessibility, expanded use of electronic health records, integration of behavioral health care, and care coordination.
There was evident progress and some satisfaction with the PCMH model, particularly regarding integrated behavioral health and, to some extent, expanded use of electronic health records. There was less evident progress with respect to improved access and reasonable wait times, which caused patients to continue to use urgent care or the emergency department as substitutes for primary care.
It is critical to understand the strengths and limitations of the PCMH model, so as to continue to improve upon and promote it. Strengths of the model were evident to participants in this study; however, challenges were also described. It is important to note that these challenges are difficult to separate from wider healthcare system issues, including inadequate incentives for value-based care, and carry implications for PCMH and other models of healthcare delivery.
以患者为中心的医疗之家（PCMH）模式是美国医疗转型的重要组成部分，它是一种基层医疗服务模式，旨在改善人群健康和患者的医疗体验，同时降低成本。PCMH 的研究通常侧重于系统层面的指标，包括医疗保健的使用和成本；而对患者和提供者对 PCMH 的体验的描述相对较少，且通常范围有限。这项研究是对纽约州多年来改进和扩展 PCMH 模式的一项混合方法评估的一部分，描述了患者和提供者对纽约州 PCMH 及其关键组成部分的体验。
评估的定性部分包括在纽约州 5 个县的 PCMH 实践中进行的患者焦点小组（n=9 组，67 名参与者）和对纽约州 PCMH 实践的提供者和实践管理人员的访谈（n=9 次访谈，共 10 名参与者）。通过这些焦点小组和访谈，我们从第一人称的角度描述了对纽约州 PCMH 模型的关键组成部分的体验和看法，包括可及性、电子健康记录的广泛使用、行为健康护理的整合以及护理协调。
PCMH 模式取得了明显的进展和一些成果，特别是在整合行为健康方面，在一定程度上也扩大了电子健康记录的使用。在改善可及性和合理等待时间方面的进展则不太明显，这导致患者继续将紧急护理或急诊作为替代基层医疗的选择。
了解 PCMH 模式的优势和局限性至关重要，以便继续改进和推广它。本研究的参与者清楚地看到了该模式的优势；然而，也描述了挑战。重要的是要注意，这些挑战与更广泛的医疗体系问题难以分开，包括基于价值的医疗保健激励不足，这对 PCMH 和其他医疗服务模式都有影响。
