Study protocol: transforming outcomes for patients through medical home evaluation and redesign: a cluster randomized controlled trial to test high value elements for patient-centered medical homes versus quality improvement

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• 作者：David A Dorr (1)
  Kenneth John McConnell (1)
  Marsha Pierre-Jacques Williams (1)
  Kimberley A Gray (1)
  Jesse Wagner (1)
  Lyle J Fagnan (1)
  Elizabeth Malcolm (2)
  
  1. Oregon Health and Science University ; SW Sam Jackson Park Rd ; Portland ; OR ; USA
  2. Stanford University ; Serra Mall ; Stanford ; CA ; USA
  
• 刊名：Implementation Science
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：10
• 期：1
• 全文大小：522 KB
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• 刊物主题：Health Promotion and Disease Prevention; Health Administration; Health Informatics;
• 出版者：BioMed Central
• ISSN：1748-5908

文摘

Background Health care in the United States is in the midst of a near perfect storm: strong cost pressures, dramatic redesign efforts like patient-centered medical homes and accountable care organizations, and a broad series of payment and eligibility reforms. To date, alternative models of care intended to reduce costs and improve outcomes have shown mixed effects in the U.S., in part due to the difficulty of performing rigorous evaluation studies that control for the broader transformation while avoiding other biases, such as organizational or clinic effect on individual patient outcomes. Our objective is to test whether clinics assigned to achieve high value elements (HVEs) of practice redesign are more likely than controls to achieve improvements in patient health and satisfaction with care and reduction in costs. Methods/Design To prepare, we interview stakeholders, align with health reform, and propose a pilot. Participants are primary care clinics engaged in reform. Study protocol requires that both arms receive monthly practice facilitation, IT-based milestone reporting, and small financial incentives based on self-determined quality improvement (QI) goals; intervention receives additional prompting to choose HVEs. Design is a cluster randomized controlled trial over 1 year with pre- and post-washout periods. Outcomes are unplanned utilization and costs, patient experience of care, quality, and team performance. Analysis is a multivariate difference-in-difference with adjustments for patient risk, intraclinic correlation, and other confounders. Discussion The TOPMED study is a cluster randomized controlled trial focused on learning how primary care practices can transform within health reform guidelines to achieve outcomes related to the Triple Aim. Trial registration ClinicalTrials.gov registration: NCT02106221.