public health analyst, RTI International, Research Triangle Park, North Carolina social scientist, RTI International research economist, RTI International senior economist and program manager, RTI International public health analyst, RTI International public health analyst, RTI International senior research public health analyst, RTI International director of research and quality, American Association of Nurse Anesthetists, Park Ridge, Illinois.
J Healthc Manag. 2020 Jan-Feb;65(1):45-60. doi: 10.1097/JHM-D-18-00186.
Certified registered nurse anesthetists (CRNAs) can practice independently or with varying degrees of supervision by physicians or anesthesiologists. Before 2001, the Centers for Medicare & Medicaid Services (CMS) conditions of participation required CRNAs to be supervised by a physician. Starting in November 2001, CMS implemented an opt-out policy to give states greater autonomy in determining how anesthesia services are delivered. The policy also provided a mechanism to increase access to anesthesia services.We sought to understand and describe surgical facility leaders' perceptions of CRNA quality, safety, and cost-effectiveness; the motivation and rationale for using different anesthesia staffing models; and facilitators and barriers to using CRNAs. We applied a mixed-methods approach to understand surgical facility leadership decision-making for staffing arrangements.The use of anesthesia staffing models differed by location and surgical facility type. For example, the predominantly CRNA model was used in only 10% of large urban hospitals but in 61% of rural ambulatory surgical centers. Interviews with surgical facility leaders revealed that geographic location, surgeon preference, and organizational inertia were powerful contributors to a facility's choice of staffing model. Other factors included the Medicare opt-out provision, facility experience, and cost considerations. Differences in quality and safety between models were not contributing factors for most facilities.
注册护士麻醉师（CRNAs）可以独立执业，也可以在医生或麻醉师的不同程度监督下执业。在 2001 年之前，医疗保险和医疗补助服务中心（CMS）的参与条件要求 CRNA 由医生监督。从 2001 年 11 月开始，CMS 实施了一项选择退出政策，赋予各州更大的自主权来确定如何提供麻醉服务。该政策还提供了一种增加获得麻醉服务机会的机制。我们试图了解和描述外科医疗机构领导对 CRNA 质量、安全性和成本效益的看法；使用不同麻醉人员配备模式的动机和理由；以及使用 CRNA 的促进因素和障碍。我们采用混合方法来了解外科医疗机构领导在人员配备安排方面的决策。麻醉人员配备模式的使用因地理位置和外科医疗机构类型而异。例如，主要使用 CRNA 的模式仅在 10%的大型城市医院中使用，但在 61%的农村门诊手术中心中使用。对外科医疗机构领导的访谈表明，地理位置、外科医生偏好和组织惰性是医疗机构选择人员配备模式的重要因素。其他因素包括医疗保险选择退出条款、医疗机构经验和成本考虑。大多数医疗机构认为，模式之间的质量和安全性差异不是决定因素。
