Rodriguez Hector P, Knox Margae, Hurley Vanessa, Rittenhouse Diane R, Shortell Stephen M
*Center for Healthcare Organizational and Innovation Research, University of California, Berkeley †Department of Family and Community Medicine, University of California, San Francisco, CA.
Med Care. 2016 Jun;54(6):632-8. doi: 10.1097/MLR.0000000000000527.
Strategies to enhance appointment access are being adopted by medical practices as part of patient-centered medical home (PCMH) implementation, but little is known about the use of these strategies nationally.
We examine practice use of open access scheduling and after-hours care.
Data were analyzed from the Third National Study of Physician Organizations (NSPO3) to examine which enhanced appointment access strategies are more likely to be used by practices with more robust PCMH capabilities and with greater external incentives. Logistic regression estimated the effect of PCMH capabilities and external incentives on practice use of open access scheduling and after-hours care.
Physician organizations with >20% primary care physicians (n=1106).
PCMH capabilities included team-based care, health information technology capabilities, quality improvement orientation, and patient experience orientation. External incentives included public reporting, pay-for-performance (P4P), and accountable care organization participation.
A low percentage of practices (19.8%) used same-day open access scheduling, while after-hours care (56.1%) was more common. In adjusted analyses, system-owned practices and practices with greater use of team-based care, health information technology capabilities, and public reporting were more likely to use open access scheduling. Accountable care organization-affiliated practices and practices with greater use of public reporting and P4P were more likely to provide after-hours care.
Open access scheduling may be most effectively implemented by practices with robust PCMH capabilities. External incentives appear to influence practice adoption of after-hours care. Expanding open access scheduling and after-hours care will require distinct policies and supports.
作为以患者为中心的医疗之家（PCMH）实施的一部分，医疗实践正在采用增强预约服务的策略，但对于这些策略在全国范围内的使用情况知之甚少。
我们研究了开放预约排班和非工作时间护理的实践使用情况。
对第三次全国医师组织研究（NSPO3）的数据进行了分析，以检验哪些增强预约服务的策略更有可能被具有更强PCMH能力和更大外部激励措施的实践所采用。逻辑回归估计了PCMH能力和外部激励措施对开放预约排班和非工作时间护理实践使用的影响。
初级保健医生比例超过20%的医师组织（n = 1106）。
PCMH能力包括团队式护理、健康信息技术能力、质量改进导向和患者体验导向。外部激励措施包括公开报告、按绩效付费（P4P）和参与 accountable care organization。
采用当日开放预约排班的实践比例较低（19.8%），而非工作时间护理（56.1%）更为常见。在调整分析中，系统所有的实践以及更多使用团队式护理、健康信息技术能力和公开报告的实践更有可能采用开放预约排班。隶属于 accountable care organization的实践以及更多使用公开报告和P4P的实践更有可能提供非工作时间护理。
具有强大PCMH能力的实践可能最有效地实施开放预约排班。外部激励措施似乎会影响实践对非工作时间护理的采用。扩大开放预约排班和非工作时间护理将需要不同的政策和支持。
