University of Wisconsin School of Medicine and Public Health.
University of Wisconsin School of Nursing.
J Clin Rheumatol. 2019 Apr;25(3):e1-e7. doi: 10.1097/RHU.0000000000000795.
Rheumatologists face time pressures similar to primary care but have not generally benefitted from optimized team-based rooming during the time from the waiting room until the rheumatologist enters the room.
The aim of this study was to assess current capacity for population management in rheumatology clinics; we aimed to measure the tasks performed by rheumatology clinic staff (medical assistants or nurses) during rooming.
We performed a cross-sectional time-study and work-system analysis to measure rooming workflows at 3 rheumatology clinics in an academic multispecialty practice during 2014-2015. We calculated descriptive statistics and compared frequencies and durations using Fisher exact test and analysis of variance.
Observing 190 rheumatology clinic previsit rooming sequences (1419 minutes), we found many significant variations. Total rooming duration varied by clinic (median, 6.75-8.25 minutes; p < 0.001). Vital sign measurement and medication reconciliation accounted for more than half of rooming duration. Among 3 clinics, two of 15 tasks varied significantly in duration, and 9 varied in frequency. Findings led clinic leaders to modify policies and procedures regarding 6 high-variation tasks streamlining assessment of weight, height, pain scores, tobacco use, disease activity, and refill needs.
Assessing rheumatology rooming tasks identified key opportunities to improve quality and efficiency without burdening providers. This project demonstrated user-friendly methods to identify opportunities to standardize rooming and support data-driven decisions regarding rheumatology clinic practice changes to improve population management in rheumatology.
风湿科医生面临着与初级保健医生类似的时间压力，但在从候诊室到风湿科医生进入诊室的这段时间里，他们通常没有从优化的基于团队的接诊中受益。
本研究旨在评估风湿科诊所的人群管理能力；我们旨在衡量风湿科诊所工作人员（医疗助理或护士）在接诊期间执行的任务。
我们在 2014-2015 年期间对一家学术多专科实践中的 3 家风湿科诊所进行了横断面时间研究和工作系统分析，以测量接诊流程。我们计算了描述性统计数据，并使用 Fisher 精确检验和方差分析比较了频率和持续时间。
观察了 190 例风湿科就诊前接诊序列（1419 分钟），我们发现了许多显著的变化。接诊总时长因诊所而异（中位数 6.75-8.25 分钟；p<0.001）。生命体征测量和药物重整占接诊时长的一半以上。在 3 家诊所中，有 15 项任务中的 2 项在持续时间上存在显著差异，9 项在频率上存在差异。研究结果促使诊所领导修改了关于 6 项高变异任务的政策和程序，这些任务简化了体重、身高、疼痛评分、吸烟状况、疾病活动度和药物续开需求的评估。
评估风湿科接诊任务确定了提高质量和效率的关键机会，同时不会给提供者带来负担。该项目展示了用户友好的方法，可以识别标准化接诊和支持数据驱动决策的机会，从而改善风湿科诊所实践变化，以改善风湿科的人群管理。
