医疗保健财务管理局（HCFA）文件要求的变化对学术急诊医学的影响：一项医师调查结果

The impact of changes in HCFA documentation requirements on academic emergency medicine: results of a physician survey.

作者信息

McLean S A, Feldman J A

机构信息

Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.

出版信息

Acad Emerg Med. 2001 Sep;8(9):880-5. doi: 10.1111/j.1553-2712.2001.tb01148.x.

DOI:10.1111/j.1553-2712.2001.tb01148.x

PMID:11535480

Abstract

BACKGROUND

The Health Care Financing Administration (HCFA) has dramatically increased documentation and procedural supervision required by faculty in academic emergency departments (EDs).

OBJECTIVES

To determine academic emergency medicine (EM) physicians' perceptions of the impact of HCFA documentation requirements (HDR) on teaching time, clinical efficiency, and job satisfaction.

METHODS

An observational cross-sectional study was done using a survey of New England academic EM faculty from September to December 1999. E-mail surveys were followed by hard copy to nonresponders. Teaching time, clinical efficiency, and job satisfaction were rated on a five-point Likert scale. Yes/no questions about other possible benefits of HCFA regulations were asked. Frequency (95% CI) and chi-square analyses were performed.

RESULTS

One hundred seventy-four of 233 (75%) responded. Eighty-nine percent (95% CI = 84% to 93%) of the respondents thought teaching time was somewhat or markedly decreased by changes in HDR (somewhat 46%, markedly 43%). Seventy-nine percent (95% CI = 73% to 85%) believed clinical efficiency was somewhat or markedly decreased by changes in HDR (somewhat 49%, markedly 30%). Eighty percent (95% CI = 73% to 86%) reported somewhat or markedly decreased job satisfaction due to changes in HDR (somewhat 56%, markedly 24%). Twenty-one percent (95% CI = 15% to 27%) believed changes in HDR had improved patient care by requiring increased patient supervision. Forty-eight percent (95% CI = 40% to 56%) thought that changes in documentation requirements had decreased medicolegal risk by improving patient documentation.

CONCLUSIONS

Most academic EM physicians in New England perceive that HDR have decreased clinical efficiency, teaching time, and job satisfaction. These findings suggest that changes in HDR may have a substantial impact on many different aspects of emergency care provided in academic settings.

摘要

背景

医疗保健财务管理局（HCFA）大幅增加了学术急诊科（ED）教员所需的文件记录和程序监督。

目的

确定学术急诊医学（EM）医生对HCFA文件要求（HDR）对教学时间、临床效率和工作满意度的影响的看法。

方法

1999年9月至12月，对新英格兰学术EM教员进行了一项观察性横断面研究，采用问卷调查。对未回复者通过电子邮件调查后再邮寄纸质问卷。教学时间、临床效率和工作满意度采用五点李克特量表进行评分。还询问了关于HCFA法规其他可能益处的是/否问题。进行了频率（95%置信区间）和卡方分析。

结果

233名受访者中有174名（75%）回复。89%（95%置信区间=84%至93%）的受访者认为HDR的变化使教学时间有所或显著减少（有所减少46%，显著减少43%）。79%（95%置信区间=73%至85%）的受访者认为HDR的变化使临床效率有所或显著降低（有所降低49%，显著降低30%）。80%（95%置信区间=73%至86%）的受访者报告称，由于HDR的变化，工作满意度有所或显著降低（有所降低56%，显著降低24%）。21%（95%置信区间=15%至27%）的受访者认为HDR的变化通过加强对患者的监督改善了患者护理。48%（95%置信区间=40%至56%）的受访者认为文件要求的变化通过改善患者文件记录降低了医疗法律风险。