Peikes Deborah N, Reid Robert J, Day Timothy J, Cornwell Derekh D F, Dale Stacy B, Baron Richard J, Brown Randall S, Shapiro Rachel J
Mathematica Policy Research, Princeton, New Jersey.
Ann Fam Med. 2014 Mar-Apr;12(2):142-9. doi: 10.1370/afm.1626.
Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative.
We undertook a descriptive analysis of CPC initiative practices' baseline staffing using data from initial applications and a practice survey. CMS selected 502 primary care practices (from 987 applicants) in 7 regions based on their health information technology, number of patients covered by participating payers, and other factors; 496 practices were included in this analysis.
Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators-all of these positions are more common in larger practices. Other clinical staff were reported infrequently regardless of practice size. Compared with other CPC initiative practices, designated patient-centered medical homes were more likely to have care managers/coordinators but otherwise had similar staff types. Larger practices had fewer FTE staff per physician.
At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost.
尽管对团队式医疗的呼声日益高涨，但初级医疗实践目前的人员构成尚不清楚。我们描述了医疗保险和医疗补助服务中心（CMS）综合初级医疗（CPC）计划中初级医疗实践的人员配置模式。
我们利用初始申请数据和一项实践调查，对CPC计划实践的基线人员配置进行了描述性分析。CMS根据健康信息技术、参与支付方覆盖的患者数量及其他因素，在7个地区从987名申请者中挑选了502家初级医疗实践；本分析纳入了496家实践。
与全国分布情况一致，本研究纳入的大多数CPC计划实践规模较小：44%报告全职等效（FTE）医生为2名或更少；27%报告超过4名。几乎所有实践都有行政人员（98%）和医疗助理（89%）。53%报告有执业护士或医师助理；47%有执业护士或职业护士；36%有注册护士；24%有护理经理/协调员——所有这些职位在规模较大的实践中更为常见。无论实践规模如何，其他临床人员的报告都很少。与其他CPC计划实践相比，指定的以患者为中心的医疗之家更有可能有护理经理/协调员，但在其他方面人员类型相似。规模较大的实践中每位医生的FTE工作人员较少。
在基线时，大多数CPC计划实践采用传统的人员配置模式，并未报告有对新的初级医疗模式可能不可或缺的专职人员，如护理协调员、健康教育工作者、行为健康专家和药剂师。没有这些人员及其服务的报酬，实践不太可能以可持续的成本为患者提供全面、协调和可及的医疗服务。
