Reed Daniel O, Hooker Roderick S
Daniel O. Reed practices corrections medicine in Canon City, Colo. He was employed at the Michael E. DeBakey VA Medical Center in Houston, Tex., at the time of the study. Roderick S. Hooker is a health policy analyst and a former VA employee. The authors have disclosed no potential conflicts of interest, financial or otherwise.
JAAPA. 2017 Apr;30(4):38-42. doi: 10.1097/01.JAA.0000513352.60771.0a.
In the Veterans Health Administration (VHA) system, most orthopedic care takes place in the VA medical centers (VAMCs). Because most patients receiving orthopedic care were referred by adult medicine providers, more widely deploying physician assistants (PAs) in orthopedic medicine might help offset this workload. An orthopedic medicine demonstration project recruited, trained, and positioned PAs in community-based outpatient clinics (CBOCs) to improve access to care. The project involved surgeons at the Houston VAMC instructing five newly employed PAs in a wide range of orthopedic evaluation and management strategies before their assignment to a CBOC. An administrative assessment compared encounter data pre- and postproject (2012 and 2014) to determine if this strategy modified orthopedic workload and improved patient access to care. By 2014, orthopedic patient visit volume had increased 31%-10% at the VAMC and 21% at the five CBOCs. Overall, the five deployed PAs managed 28% of all orthopedic encounters spread over 1 year and only 3.2% of visits required VAMC referral for further evaluation or treatment. During the project, the total volume of patient visits increased throughout the Houston VAMC region but access to care for this specialty service also increased, with more veteran musculoskeletal care being met at the five CBOCs, off-loading visit demand centrally. The adaptability and flexibility of new roles has been identified as one of the defining characteristics of PAs. That the VHA can take advantage of this role malleability suggests that employing PAs is useful in meeting medical service needs of veterans.
在退伍军人健康管理局（VHA）系统中，大多数骨科护理在退伍军人事务部医疗中心（VAMC）进行。由于大多数接受骨科护理的患者是由成人医学提供者转诊而来的，因此在骨科医学中更广泛地部署医师助理（PA）可能有助于减轻这一工作量。一个骨科医学示范项目在社区门诊诊所（CBOC）招募、培训并安置了医师助理，以改善医疗服务的可及性。该项目让休斯顿退伍军人事务部医疗中心的外科医生在将五名新雇佣的医师助理分配到社区门诊诊所之前，指导他们掌握广泛的骨科评估和管理策略。一项行政评估比较了项目前后（2012年和2014年）的诊疗数据，以确定该策略是否改变了骨科工作量并改善了患者获得医疗服务的机会。到2014年，退伍军人事务部医疗中心的骨科患者就诊量增加了31%——在退伍军人事务部医疗中心增加了10%，在五个社区门诊诊所增加了21%。总体而言，五名已部署的医师助理在一年时间里处理了所有骨科诊疗病例的28%，只有3.2%的就诊需要转诊到退伍军人事务部医疗中心进行进一步评估或治疗。在该项目期间，休斯顿退伍军人事务部医疗中心区域内患者就诊总量增加，但该专科服务的医疗服务可及性也有所提高，五个社区门诊诊所满足了更多退伍军人的肌肉骨骼护理需求，从而减轻了中心的就诊需求。新角色的适应性和灵活性已被确定为医师助理的决定性特征之一。退伍军人健康管理局能够利用这一角色的可塑性，这表明雇佣医师助理有助于满足退伍军人的医疗服务需求。
