Mathematica Policy Research, Princeton, New Jersey
Mathematica Policy Research, Princeton, New Jersey.
Ann Fam Med. 2020 May;18(3):227-234. doi: 10.1370/afm.2515.
Practices in the 4-year Comprehensive Primary Care (CPC) initiative changed staffing patterns during 2012-2016 to improve care delivery. We sought to characterize these changes and to compare practice patterns with those in similar non-CPC practices in 2016.
We conducted an online survey among selected US primary care practices. We statistically tested 2012-2016 changes in practice-reported staff composition among 461 CPC practices using 2-tailed tests. Using logistic regression analysis, we compared differences in staff types between the CPC practices and 358 comparison practices that participated in the survey in 2016.
In 2012, most CPC practices reported having physicians (100%), administrative staff (99%), and medical assistants (90%). By 2016, 84% reported having care managers/care coordinators (up from 24% in 2012), and 29% reported having behavioral health professionals, clinical psychologists, or social workers (up from 19% in 2014). There were also smaller increases (of less than 10 percentage points) in the share of practices having pharmacists, nutritionists, registered nurses, quality improvement specialists, and health educators. Larger and system-affiliated practices were more likely to report having care managers/care coordinators and behavioral health professionals. In 2016, relative to comparison practices, CPC practices were more likely to report having various staff types-notably, care managers/care coordinators (84% of CPC vs 36% of comparison practices), behavioral health professionals (29% vs 12%), and pharmacists (18% vs 4%).
During the CPC initiative, CPC practices added different staff types to a fairly traditional staffing model of physicians with medical assistants. They most commonly added care managers/care coordinators and behavioral health staff to support the CPC model and, at the end of CPC, were more likely to have these staff members than comparison practices.
在 2012-2016 年间，综合初级保健（CPC）计划中的实践改变了人员配置模式，以改善医疗服务的提供。我们试图描述这些变化，并将其与 2016 年类似的非 CPC 实践模式进行比较。
我们在美国选定的初级保健实践中进行了在线调查。我们使用双侧检验统计测试了 461 个 CPC 实践中 2012-2016 年实践报告的员工构成变化。使用逻辑回归分析，我们比较了 CPC 实践和参与 2016 年调查的 358 个对照实践之间的员工类型差异。
2012 年，大多数 CPC 实践报告拥有医生（100%）、行政人员（99%）和医疗助理（90%）。到 2016 年，84%的实践报告拥有护理经理/护理协调员（比 2012 年的 24%有所增加），29%的实践报告拥有行为健康专业人员、临床心理学家或社会工作者（比 2014 年的 19%有所增加）。拥有药剂师、营养师、注册护士、质量改进专家和健康教育者的实践比例也略有增加（不到 10 个百分点）。较大和系统附属的实践更有可能报告拥有护理经理/护理协调员和行为健康专业人员。2016 年，与对照实践相比，CPC 实践更有可能报告拥有各种员工类型——特别是护理经理/护理协调员（84%的 CPC 实践 vs. 36%的对照实践）、行为健康专业人员（29% vs. 12%）和药剂师（18% vs. 4%）。
在 CPC 计划期间，CPC 实践在医生加医疗助理的传统人员配置模式上增加了不同的员工类型。他们最常增加护理经理/护理协调员和行为健康人员，以支持 CPC 模式，在 CPC 计划结束时，他们比对照实践更有可能拥有这些员工。
