Leroux Todd C, Côté Murray J, Kum Hye-Chung, Dabney Alan, Wells Rebecca
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Department of Health Policy and Management, Texas A&M University School of Public Health, 1266 TAMU, College Station, TX 77843.
Mil Med. 2017 Mar;182(3):e1741-e1746. doi: 10.7205/MILMED-D-16-00180.
Recent implementation of the Patient-Centered Medical Home (PCMH) in military primary care has gained significant traction and attention from leadership and policy makers. The study objective was to measure the rate of change in appointment availability before and after primary care clinics were certified as a medical home. Access to care is one core tenet of the medical home and appointment availability is an important indicator of access.
This was a retrospective, longitudinal observational study involving 21 U.S. Navy primary care clinics from 2011 to 2014. Appointment availability, as measured by third next available appointment, was constructed for 21 primary care clinics over a 29-month time period (14 months precertification, certification month, 14 months postcertification). A mixed-effects model with linear splines was applied where third next available appointment was the dependent variable. Main interest independent variables include time (precertification and postcertification). Remaining independent variables include categories pertaining to clinic characteristics, ancillary services, and nonemergent primary care treatable emergency department visits.
Appointment availability improved slightly postcertification. Although there were statistically significant differences in appointment availability pre- and postcertification, the differences were so small that patients may not actually experience noticeable improvements.
Although slight improvements in appointment availability following medical home certification exist, adoption of the medical home model in the military setting may not have all the potential outcomes expected on the basis of prior findings in civilian settings. This study demonstrated that improvements in appointment availability following medical home certification exist, but are quite small. Patients, as a result, are unlikely to notice any improvements. Additional research should test other expected benefits of PCMH in military settings. At that point, military policy makers can decide which aspects of PCMH practices merit sustaining.
近期，以患者为中心的医疗之家（PCMH）在军队基层医疗中得到实施，受到了领导层和政策制定者的广泛关注。本研究的目的是衡量基层医疗诊所被认证为医疗之家前后预约可及性的变化率。获得医疗服务是医疗之家的一项核心原则，而预约可及性是获得医疗服务的一个重要指标。
这是一项回顾性纵向观察研究，涉及2011年至2014年期间的21家美国海军基层医疗诊所。通过计算第三个可预约时间来衡量预约可及性，在29个月的时间段内（认证前14个月、认证当月、认证后14个月）对21家基层医疗诊所进行评估。应用带有线性样条的混合效应模型，其中第三个可预约时间为因变量。主要的自变量包括时间（认证前和认证后）。其余自变量包括与诊所特征、辅助服务以及非紧急基层医疗可治疗的急诊科就诊相关的类别。
认证后预约可及性略有改善。尽管认证前后预约可及性存在统计学上的显著差异，但差异非常小，患者可能实际上并不会感受到明显的改善。
尽管医疗之家认证后预约可及性略有改善，但在军队环境中采用医疗之家模式可能并未产生基于先前在 civilian settings（此处原文有误，推测应为“民用环境”）中的研究结果所预期的所有潜在结果。本研究表明，医疗之家认证后预约可及性有所改善，但幅度很小。因此，患者不太可能注意到任何改善。应进行更多研究，以测试PCMH在军队环境中的其他预期益处。届时，军队政策制定者可以决定PCMH实践的哪些方面值得持续推行。
