The most used and most helpful facilitators for patient-centered medical home implementation

Implementation Science

Christian D Helfrich³  Lisa S Meredith¹  Jeff Luck⁴  Karin M Nelson³  Thomas Taylor⁵  Steven M Asch²  Randall C Gale⁵ 

[1] RAND Corporation, Santa Monica, CA, USA;Division of General Medical Disciplines, Stanford University, Palo Alto, CA, USA;Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA;College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA;Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 790 Willow Road, Menlo Park 94025, CA, USA

关键词: Provider self-efficacy;    Implementation resources;    Patient-centered medical home;   

Others  :  1219040
DOI  :  10.1186/s13012-015-0246-9

 received in 2014-11-20, accepted in 2015-04-13,  发布年份 2015

【 摘 要 】

Background

Like other transformative healthcare initiatives, patient-centered medical home (PCMH) implementation requires substantial investments of time and resources. Even though PCMH and PCMH-like models are being implemented by multiple provider practices and health systems, little is known about what facilitates their implementation. The purpose of this study was to assess which PCMH-implementation resources are most widely used, by whom, and which resources primary care personnel find most helpful.

Methods

This study is an analysis of data from a cross-sectional survey of primary care personnel in the Veterans Health Administration in 2012, in which respondents were asked to rate whether they were aware of and accessed PCMH-implementation resources, and to rate their helpfulness. Logistic regression was used to produce odds ratios for the outcomes (1) resource use and (2) resource helpfulness. Respondents were nested within clinics, nested, in turn, within 135 parent hospitals.

Results

Teamlet huddles were the most widely accessed (80.4% accessed) and most helpful (90.4% rated helpful) resource; quality-improvement methods to conduct small tests of change were the least frequently accessed (42.4% accessed) resource though two-thirds (66.7%) of users reported as helpful. Supervisors were significantly more likely (ORs, 1.46 to 1.86) to use resources than non-supervisors but were less likely to rate the majority (8 out of 10) of resources as “somewhat/very helpful” than non-supervisors (ORs, 0.72 to 0.84). Longer-tenured employees tended to rate resources as more helpful.

Conclusions

These findings are the first in the PCMH literature that we are aware of that systematically assesses primary care staff’s access to and the helpfulness of PCMH implementation resources. Supervisors generally reported greater access to resources, relative to non-supervisors, but rated resources as less helpful, suggesting that information about them may not have been optimally disseminated. Knowing what resources primary care staff use and find helpful can inform administrators’ and policymakers’ investments in PCMH-implementation resources. The implications of our model extend beyond just PCMH implementation but also to considerations when providing implementation resources for other complex quality-improvement initiatives.

【 授权许可】

   
2015 Gale et al.; licensee BioMed Central.

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