Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial.

Tracy Marie Anastas, Jesse Wagner, Rachel Lauren Ross, Bhavaya Sachdeva, LeAnn Michaels, Kimberley Gray, Katie Cartwright, David A Dorr
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引用次数: 3

Abstract

Introduction: Like most patient-centered medical home (PCMH) models, Oregon's program, the Patient-Centered Primary Care Home (PCPCH), aims to improve care while reducing costs; however, previous work shows that PCMH models do not uniformly achieve desired outcomes. Our objective was to describe a process for refining PCMH models to identify high value elements (HVEs) that reduce cost and utilization.

Methods: We performed a targeted literature review of each PCPCH core attribute. Value-related concepts and their metrics were abstracted, and studies were assessed for relevance and strength of evidence. Focus groups were held with stakeholders and patients, and themes related to each attribute were identified; calculation of HVE attainment versus PCPCH criteria were completed on eight primary care clinics. Analyses consisted of descriptive statistics and criterion validity with stakeholder input.

Results: 2,126 abstracts were reviewed; 22 met inclusion criteria. From these articles and focus groups of stakeholders/experts (n = 49; 4 groups) and patients (n = 7; 1 group), 12 HVEs were identified that may reduce cost and utilization. At baseline, clinics achieved, on average, 31.3 percent HVE levels compared to an average of 87.9 percent of the 35 PCMH measures.

Discussion: A subset of measures from the PCPCH model were identified as "high value" in reducing cost and utilization. HVE performance was significantly lower than standard measures, and may better calibrate clinic ability to reduce costs.

Conclusion: Through literature review and stakeholder engagement, we created a novel set of high value elements for advanced primary care likely to be more related to cost and utilization than other models.

为TOPMED试验定义以患者为中心的医疗之家降低成本和利用的高价值元素。
简介:像大多数以病人为中心的医疗之家(PCMH)模式一样,俄勒冈州的项目,以病人为中心的初级保健之家(PCPCH),旨在改善护理,同时降低成本;然而,先前的工作表明PCMH模型并不能一致地达到预期的结果。我们的目标是描述一个改进PCMH模型的过程,以确定降低成本和利用率的高价值元素(HVEs)。方法:我们对每个PCPCH核心属性进行了有针对性的文献综述。与价值相关的概念及其度量被抽象出来,并评估研究的相关性和证据的强度。与利益攸关方和患者举行焦点小组讨论,确定与每个属性相关的主题;在8个初级保健诊所完成了HVE实现与PCPCH标准的计算。分析包括描述性统计和标准效度与利益相关者的输入。结果:共回顾文献2126篇;22例符合纳入标准。从这些文章和利益相关者/专家的焦点小组(n = 49;4组)和患者(n = 7;1组),确定了12个可能降低成本和利用率的HVEs。在基线时,诊所平均达到31.3%的HVE水平,而在35项PCMH措施中,平均达到87.9%。讨论:来自PCPCH模型的措施子集在降低成本和利用率方面被确定为“高价值”。HVE的表现明显低于标准措施,可能更好地校准临床能力,降低成本。结论:通过文献回顾和利益相关者参与,我们为高级初级保健创造了一套新的高价值要素,这些要素可能比其他模型更与成本和利用率相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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