流程再造和以患者为中心的方法加强了专科护理的效率。

Process reengineering and patient-centered approach strengthen efficiency in specialized care.

机构信息

Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla 1, 28222 Majadahonda, Madrid, Spain. Email:

出版信息

Am J Manag Care. 2019 Feb 1;25(2):e50-e57.

Abstract

OBJECTIVES

To improve multiple levels of utilization and efficiency in specialized outpatient consults using information technology-based systems, process reengineering, and patient-centeredness.

STUDY DESIGN

Prospective research from 2008 to 2014 conducted in a hospital in Madrid, Spain. Quantitative analysis of 1,162,477 consecutive consultation requests and qualitative techniques of 72,368 surveys using a structured questionnaire.

METHODS

Key performance indicators were evaluated: operational outcomes (productivity, time gap between requested consultations and performance, staffing accuracy, wait time, and underlying variability), administrative burden (downtime losses; no-show, drop-in, cancelled, and rescheduled visits), perceived quality scores, and income. Data mining, modeling seasonality in demand, process reengineering, and a patient-centered approach were incorporated as strategies to drive changes.

RESULTS

Productivity increased 34% for the entire period, closing the gap between consultation request and performance from 43.7% to 8.7%. Wait time decreased from 82.7 to 7.9 days, with an 82.9% reduction in interservice variability. Staffing adjustments prevented understaffing situations; more accurate modeling reduced understaffing from 282 to 4 full-time equivalent staff. A seasonal autoregressive integrated moving average (1,0,0)(0,1,0) model explained 90.3% of forecasted data variability with an absolute percentage error between 2.4% and 8.3%. The project reduced administrative burden, inefficiency, and downtime losses by 47.3%, 53.7%, and 54.5%, respectively. Perceived quality indices improved by 19.6%, and complaints were reduced from 63 to 10 per 10,000 consultation-years. Hospital incomes rose by 49.4%.

CONCLUSIONS

Improving efficiency is complex and requires a multimodal approach. Health information systems, patient feedback, and multidisciplinary teams are components that can improve clinical processes.

摘要

目的

通过信息技术系统、流程再造和以患者为中心的方式，提高专科门诊就诊的多个层次的利用率和效率。

研究设计

2008 年至 2014 年在西班牙马德里的一家医院进行的前瞻性研究。对 1162477 例连续就诊请求进行定量分析，并使用结构化问卷进行 72368 例调查的定性技术。

方法

评估关键绩效指标：运营成果（生产力、请求就诊和就诊之间的时间差距、人员配置准确性、等待时间和潜在变异性）、行政负担（停机损失；未出现、临时访问、取消和重新安排的就诊）、感知质量评分和收入。数据挖掘、需求季节性建模、流程再造和以患者为中心的方法被纳入推动变革的策略。

结果

整个期间的生产力提高了 34%，就诊请求和就诊之间的差距从 43.7%缩小到 8.7%。等待时间从 82.7 天减少到 7.9 天，跨服务变异性降低了 82.9%。人员配置调整防止了人员不足的情况；更准确的建模将人员不足从 282 名减少到 4 名全职等效人员。季节性自回归综合移动平均（1,0,0）（0,1,0）模型解释了 90.3%的预测数据变异性，绝对百分比误差在 2.4%至 8.3%之间。该项目分别减少了 47.3%、53.7%和 54.5%的行政负担、低效率和停机损失。感知质量指数提高了 19.6%，投诉从每 10000 次就诊年 63 次减少到 10 次。医院收入增长了 49.4%。