Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, USA.
University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
J Gen Intern Med. 2020 Feb;35(2):523-530. doi: 10.1007/s11606-019-05541-2. Epub 2019 Nov 14.
To identify priorities for improving healthcare organization management of patient access to primary care based on prior evidence and a stakeholder panel.
Studies on healthcare access show its importance for ensuring population health. Few studies show how healthcare organizations can improve access.
We conducted a modified Delphi stakeholder panel anchored by a systematic review. Panelists (N = 20) represented diverse stakeholder groups including patients, providers, policy makers, purchasers, and payers of healthcare services, predominantly from the Veterans Health Administration. A pre-panel survey addressed over 80 aspects of healthcare organization management of access, including defining access management. Panelists discussed survey-based ratings during a 2-day in-person meeting and re-voted afterward. A second panel process focused on each final priority and developed recommendations and suggestions for implementation.
The panel achieved consensus on definitions of optimal access and access management on eight urgent and important priorities for guiding access management improvement, and on 1-3 recommendations per priority. Each recommendation is supported by referenced, panel-approved suggestions for implementation. Priorities address two organizational structure targets (interdisciplinary primary care site leadership; clearly identified group practice management structure); four process improvements (patient telephone access management; contingency staffing; nurse management of demand through care coordination; proactive demand management by optimizing provider visit schedules), and two outcomes (quality of patients' experiences of access; provider and staff morale). Recommendations and suggestions for implementation, including literature references, are summarized in a panelist-approved, ready-to-use tool.
A stakeholder panel informed by a pre-panel systematic review identified eight action-oriented priorities for improving access and recommendations for implementing each priority. The resulting tool is suitable for guiding the VA and other integrated healthcare delivery organizations in assessing and initiating improvements in access management, and for supporting continued research.
根据现有证据和利益相关者小组，确定改善医疗保健组织管理患者获得初级保健的优先事项。
关于医疗保健可及性的研究表明，其对确保人口健康非常重要。但很少有研究表明医疗保健组织如何改善可及性。
我们进行了一项经过修改的德尔菲利益相关者小组研究，以系统评价为基础。小组成员（N=20）代表了包括患者、提供者、政策制定者、购买者和医疗保健服务支付者在内的不同利益相关者群体，主要来自退伍军人健康管理局。在小组会议之前进行的一项预小组调查涉及医疗保健组织管理可及性的 80 多个方面，包括定义可及性管理。小组成员在为期两天的面对面会议上讨论了基于调查的评分，并在会后重新投票。第二个小组过程重点关注每个最终的优先事项，并制定了实施建议。
该小组就优化可及性和可及性管理的定义达成了共识，确定了指导可及性管理改进的八项紧急和重要的优先事项，并为每项优先事项提出了 1-3 项建议。每项建议都得到了参考的、小组批准的实施建议的支持。优先事项涉及两个组织结构目标（跨学科初级保健现场领导力；明确的小组实践管理结构）；四项流程改进（患者电话可及性管理；应急人员配置；通过护理协调管理需求的护士管理；通过优化提供者就诊时间安排主动管理需求）和两个结果（患者对可及性体验的质量；提供者和员工士气）。总结了一个小组批准的、可立即使用的工具中的建议和实施建议，包括文献参考。
一个由预小组系统评价提供信息的利益相关者小组确定了八项以行动为导向的改善可及性的优先事项，并为实施每项优先事项提出了建议。由此产生的工具适用于指导退伍军人事务部和其他综合医疗保健服务组织评估和启动可及性管理的改进，并支持持续研究。
