Introduction 

Patient-Centered Medical Home (PCMH) recognition is designed to promote whole-person team-based and integrated care.

Purpose 

Our goal was to assess changes in staffing infrastructure that promoted team-based and integrated care delivery before and after PCMH recognition in Health Resources & Services Administration (HRSA)-funded health centers (HCs).

Methodology/Approach 

We identified changes in staffing 2 years before and 3 years after PCMH recognition using 2010–2019 Uniform Data System data among three cohorts of HCs that received PCMH recognition in 2013 (n = 346), 2014 (n = 207), and 2015 (n = 115). Our outcomes were team-based ratio (full-time equivalent medical and nonmedical providers and staff to one primary care physician) and a multidisciplinary staff ratio (allied medical and nonmedical staff to 1,000 patients). We used mixed-effects Poisson regression models.

Results 

The earlier cohorts served fewer complex patients and were larger before PCMH recognition. Three years following recognition, the 2013 and 2014 cohorts had significantly larger team-based ratios, and all three cohorts had significantly larger multidisciplinary staff ratios. Cohorts varied, however, in the type of staff that drove this change. Both ratios increased in the longer term.

Conclusion 

Our study suggests that growth in team-based and multidisciplinary staff ratios in each cohort may have been due to a combination of HCs’ perceptions of need for specific services, HRSA funding, and technical assistance opportunities.

Policy Implications 

Further research is needed to understand barriers such as costs of employing a multidisciplinary staff, particularly those that cannot directly bill for services as well as whether such changes lead to practice transformation and improved quality of care.

中文翻译：

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卫生资源与服务管理局资助的卫生中心在以患者为中心的医疗之家获得认可后进行人员配置转型

介绍 

以患者为中心的医疗之家 (PCMH) 认可旨在促进以团队为基础的全人综合护理。

目的 

我们的目标是评估在 PCMH 获得卫生资源与服务管理局 (HRSA) 资助的卫生中心 (HC) 前后促进基于团队和综合护理服务的人员配备基础设施的变化。

方法论/方法 

我们使用 2010-2019 年统一数据系统数据，确定了 2013 年（n = 346）、2014 年（n = 207）和 2015 年（n = 115）。我们的结果是基于团队的比例（全职医疗和非医疗提供者和工作人员与一名初级保健医生）和多学科人员比例（专职医疗和非医疗人员与 1,000 名患者）。我们使用混合效应泊松回归模型。

结果 

较早的队列服务于较少的复杂患者，并且在 PCMH 识别之前更大。在获得认可三年后，2013 年和 2014 年队列的基于团队的比率明显更高，并且所有三个队列的多学科员工比率都显着增加。然而，队列中推动这一变化的员工类型各不相同。从长期来看，这两个比率都在增加。

结论 

我们的研究表明，每个队列中基于团队和多学科的员工比例的增长可能是由于 HC 对特定服务需求的看法、HRSA 资金和技术援助机会的结合。

政策影响 

需要进一步研究以了解障碍，例如雇用多学科员工的成本，特别是那些不能直接为服务计费的员工，以及这些变化是否会导致实践转型和提高护理质量。