The George Washington University, Fitzhugh Mullan Institute for Health Workforce Equity, Washington, DC, USA.
Med Care Res Rev. 2021 Feb;78(1_suppl):18S-29S. doi: 10.1177/1077558720960893. Epub 2020 Sep 23.
This study asks how much and why the productivity of advanced practice clinicians (APCs; nurse practitioners and physician assistants) varies across community health centers (CHCs), as measured in their marginal contribution to overall patient visits. We found APCs in the 90th percentile CHCs provide about 1,840 adjusted-visits per year, whereas APCs in the 10th percentile CHCs provide about 978 adjusted-visits per year. We interviewed leadership at 14 high APC and 16 low APC productivity CHCs to elicit organizational conditions that could explain the difference. Using content analysis and then qualitative comparative analysis, we found several important conditions were more common among high productivity CHCs, including scheduling APCs and physicians for the same number of visits, parity in terms of any financial incentives, and formal education programs for new APCs during onboarding/transition to practice.
本研究旨在探讨在以边际贡献衡量的整体就诊量方面，高级执业医师（APC；执业护士和医师助理）在社区卫生中心（CHC）的工作效率因何以及在多大程度上存在差异。我们发现，在排名前 90%的 CHC 中，APC 每年提供的调整就诊量约为 1840 次，而排名后 10%的 CHC 中，APC 每年提供的调整就诊量约为 978 次。我们采访了 14 家 APC 生产力较高的 CHC 和 16 家 APC 生产力较低的 CHC 的领导层，以了解可能导致这种差异的组织条件。通过内容分析和定性比较分析，我们发现，在生产力较高的 CHC 中，有几个重要条件更为常见，包括为 APC 和医生安排相同数量的就诊、在任何财务激励方面保持平等，以及为新入职的 APC 提供入职/过渡到实践的正式教育计划。
