本科毕业设计（论文）

外 文 翻 译

原文：

Teaching Primary Care in Community Health Centers

THE TEACHING HEALTH CENTER: A DEFINITIVE APPROACH TO THESE KEY PROBLEMS

By expanding and integrating existing programs and resources, we propose to establish primary care resident ambulatory training programs in community health centers. These programs could begin increasing the output of well-trained primary care physicians, many of whom would be committed to caring for the underserved, as soon as July 2011. Teaching health centers would be required to be located in a community health center in a primary care health professional shortage area as designated by the Health Resources and Services Administration; be affiliated with a residency program in family medicine, internal medicine, or pediatrics and capable of using this setting for primary care resident ambulatory training; be part of an established community health center with the capability to expand and staff the center, as well as be part of a community governance board committed to supporting both the educational and service missions; and have implemented or intend to implement National Committee for Quality Assurance tier-2 requirements for a patient-centered medical home . The patient-centered medical home is a practice model that effectively supports the core functions of primary care, uses electronic medical records, and emphasizes prevention and the management of chronic disease . Qualification criteria for these programs have been described in detail elsewhere .

Primary care residents would be the principal providers of primary care services, in close partnership with appropriate faculty, during a 12-month block of clinic training as a third-year resident. Ideally, first- and second-year residents would be assigned to the teaching health centers for their continuity clinics. Then, as third-year residents, they would be well grounded in clinic logistics and capable of performing as an effective team leader. Third-year residents would work in a practice that emphasized continuity of care, with robust faculty support for the development of resident team management and ambulatory clinical skills. Continuity of care would be ensured through the close working relationship between the resident and the supervising faculty member. This arrangement would provide the capacity to deliver coordinated, high-quality, and accessible care—with a substantially increased patient volume—because of the efficiencies of the patient-centered medical home and the physician multiplier effect of senior residents. Because this model would deviate from current training guidelines, it would be necessary for sponsoring institutions to obtain waivers from the family medicine, internal medicine, and pediatrics residency review committees.

IMPLEMENTATION AND PROJECTED OUTCOME

If health care reform legislation that includes the currently proposed community health center and primary care initiatives passes, our proposal is clearly attainable. If successful, it could result in substantial savings from the effects of prevention, effective chronic disease management, and decreases in emergency department use and hospitalizations . In 2000, an estimated 5 million admissions to U.S. hospitals, with a resulting cost of more than $26.5 billion, may have been preventable with high-quality primary and preventive care treatment . Teaching health centers would contribute to the restructuring of our health care system by expanding access to the value provided by primary care . This new cadre of primary care physicians would be trained in an environment that used electronic medical records and emphasized cost control and the elimination of waste . Supervising faculty would insist on evidence-based use of imaging and laboratory studies, as well as the prescription of generic drugs.

Our proposal would also develop the capacity of teaching health centers as sites for undergraduate ambulatory medical education and serve to stimulate medical students to choose primary care as a career. Ambulatory training sites for medical students are greatly needed, especially with the recent expansion of medical school class size. In addition, these clinics would be excellent sites for training nurse clinicians, physician assistants, pharmacists, social workers, and medical assistants.

Teaching health centers could be evaluated by using several readily quantifiable parameters. Affiliated academic institutions could obtain data regarding clinical productivity, trainee satisfaction, recruitment of graduates to underserved areas, cost of care, increased training opportunities for other health professionals, and patient satisfaction. These outcomes could then be used to support legislation for subsequent expansion.

DISCUSSION

Our proposal is designed to build a primary care workforce that can function effectively in our evolving health care environment and will improve access to care for many Americans. It is based on the development of teaching health centers that will immediately expand the clinical capacity of selected community health centers and replenish the pipeline of primary care physicians. Because of the similarity between the Massachusetts 2006 Health Reform plan and the types of national reform most likely to be implemented, analysis of the recent Massachusetts experience is of great value in establishing national policy. A recently published report from the Kaiser Commission on Medicaid and the Uninsured . emphasizes the critical role of community health centers in health care reform; in Massachusetts in 2007, they served 1 out of every 13 residents. Health insurance expansion led to a great increase in the demand for primary health care, especially in medically underserved, low-income communities. Accommodating this increase in demand requires

剩余内容已隐藏，支付完成后下载完整资料

资料编号：[488313]，资料为PDF文档或Word文档，PDF文档可免费转换为Word