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背景以患者为中心的医疗之家(PCMH)服务模式有望改善医疗服务质量、降低医疗服务成本。本研究调查了某医疗集团所辖57家诊所为获得国家质量评估委员会(NCQA)评估的三级PCMH资格所花费的直接费用,以期在转型为PCMH模式所需时间和费用方面为其他机构提供参考。方法以Health Texas集团领导、医生、执业管理人员及办公室管理人员为研究对象,进行结构化访谈,内容包括转型为PCMH、申请NCQA认证的时间和相关费用。采用自拟量表对Health Texas集团旗下获得NCQA三级PCMH认证的所有诊所进行调查。首次获得NCQA认证诊所的有效应答率为44.6%,获得NCQA续展认证诊所的有效应答率为35.7%。花费的时间(小时)乘以平均小时工资(工资依照工种计算)得出的数值,加上各种观察到的支出,最终得出花费的直接费用。结果 Health Texas集团首次获得NCQA三级PCMH认证时(2010—2012年)共花费了1 508 503美元,续展认证时(2014—2016年)共花费了346 617美元;协调护理资源每年需额外花费390 790美元。一个5例医生执业规模的Health Texas集团下属诊所,估计首次获得NCQA三级PCMH认证工资方面需额外支出10 669美元(239.5工时),获得续展认证需额外支出4 957美元(110.5工时)。结论集团化的PCMH服务模式降低了执业成本。然而,在大量证据证明PCMH服务模式改善了医疗服务质量、降低了医疗服务成本时,也应考虑到实施PCMH服务模式机构为获得这种良好结果所花费的大量时间与费用。
Background Patient-centric PCMH service model is expected to improve the quality of medical services and reduce the cost of healthcare services. This study investigated the direct costs incurred by 57 medical clinics under a healthcare group in qualifying for Level 3 PCMH assessed by the National Quality Assessment Board (NCQA) in order to provide references to other agencies in terms of the time and cost of transitioning to PCMH mode . Methods A structured interview was conducted with Health Texas Group leaders, physicians, practice managers and office managers on the transition to PCMH, time and related costs for applying for NCQA certification. All Health Texas Group clinics of all NCQA Level 3 PCMH accredited clinics were investigated using a self-administered scale. For the first time, the NCQA certification clinic had an effective response rate of 44.6% and the NCQA renewal certification clinic had an effective response rate of 35.7%. The time (in hours) multiplied by the value of the average hourly wage (in terms of the type of work) plus the various observed expenditures leads to the direct cost of the outgoings. Results Health Texas Group spent a total of $ 1,508,503 for the first NCQA Level 3 PCMH certification (2010-2012) and a total of $ 346,617 for renewal certification (2014-2016); additional annual coordination of care resources $ 390,790. An under-five Health Texas Group practice clinic requires an additional expenditure of $ 10,669 (239.5 working hours) for the first NCQA Level 3 certified PCMH certification and an additional expenditure of $ 4,957 (110.5 working hours) on renewal accreditation. Conclusion The clustered PCMH service model reduces practice costs. However, when there is ample evidence that the PCMH service model improves the quality of medical care and reduces the cost of healthcare, significant time and expense are needed to implement the PCMH service model agency to achieve this positive result.