Department of Medicine, University of Alberta, Canada.
Can J Cardiol. 2009 Dec;25(12):697-702. doi: 10.1016/s0828-282x(09)70530-6.
Universal access to health care is valued in Canada but increasing wait times for services (eg, cardiology consultation) raise safety questions. Observations suggest that deficiencies in the process of care contribute to wait times. Consequently, an outpatient clinic was designed for Ensuring Access and Speedy Evaluation (Cardiac EASE) in a university group practice, providing cardiac consultative services for northern Alberta. Cardiac EASE has two components: a single-point-ofentry intake service (prospective testing using physician-approved algorithms and previsit triage) and a multidisciplinary clinic (staffed by cardiologists, nurse practitioners and doctoral-trained pharmacists).
It was hypothesized that Cardiac EASE would reduce the time to initial consultation and a definitive diagnosis, and also increase the referral capacity.
The primary and secondary outcomes were time from referral to initial consultation, and time to achieve a definitive diagnosis and management plan, respectively. A conventionally managed historical control group (three-month pre-EASE period in 2003) was compared with the EASE group (2004 to 2006). The conventional referral mechanism continued concurrently with EASE.
A comparison between pre-EASE (n=311) and EASE (n=3096) revealed no difference in the mean (+/- SD) age (60+/-16 years), sex (55% and 52% men, respectively) or reason for referral, including chest pain (31% and 40%, respectively) and arrhythmia (27% and 29%, respectively). Cardiac EASE reduced the time to initial cardiac consultation (from 71+/-45 days to 33+/-19 days) and time to a definitive diagnosis (from 120+/-86 days to 51+/-58 days) (P<0.0001). The annual number of new referrals increased from 1512 in 2002 to 2574 in 2006 due to growth in the Cardiac EASE clinic. The number of patients seen through the conventional referral mechanism and their wait times remained constant during the study period.
Cardiac EASE reduced wait times, increased capacity and shortened time to achieve a diagnosis. The EASE model could shorten wait times for consultative services in Canada.
在加拿大，全民享有医疗保健服务是受到重视的，但服务（例如心脏病学咨询）的等待时间不断延长引发了安全问题。观察结果表明，护理过程中的缺陷是导致等待时间延长的原因之一。因此，在一个大学综合实践中设计了一个名为 Ensuring Access and Speedy Evaluation（Cardiac EASE）的门诊诊所，为艾伯塔省北部提供心脏咨询服务。Cardiac EASE 有两个组成部分：单点入口服务（使用医生批准的算法和预诊分诊进行前瞻性测试）和多学科诊所（由心脏病专家、护士从业者和博士培训药剂师组成）。
假设 Cardiac EASE 将减少初始咨询和明确诊断的时间，同时增加转诊能力。
主要和次要结果分别为从转诊到初始咨询的时间，以及实现明确诊断和管理计划的时间。将一个传统管理的历史对照组（2003 年 EASE 前三个月）与 EASE 组（2004 年至 2006 年）进行比较。传统转诊机制与 EASE 同时进行。
在 EASE 前（n=311）和 EASE 期间（n=3096）之间的比较中，年龄（60+/-16 岁）、性别（分别为 55%和 52%的男性）或转诊原因（包括胸痛（分别为 31%和 40%）和心律失常（分别为 27%和 29%）没有差异。Cardiac EASE 缩短了初始心脏咨询的时间（从 71+/-45 天缩短至 33+/-19 天）和明确诊断的时间（从 120+/-86 天缩短至 51+/-58 天）（P<0.0001）。由于 Cardiac EASE 诊所的增长，新转诊人数从 2002 年的 1512 人增加到 2006 年的 2574 人。在研究期间，通过传统转诊机制就诊的患者数量及其等待时间保持不变。
Cardiac EASE 缩短了等待时间，增加了容量，并缩短了获得诊断的时间。EASE 模式可以缩短加拿大咨询服务的等待时间。
