Allied Health Clinical Rsearch Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.
La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
BMC Health Serv Res. 2020 Oct 21;20(1):968. doi: 10.1186/s12913-020-05824-z.
Timely access is a challenge for providers of outpatient and community-based health services, as seen by the often lengthy waiting lists to manage demand. The Specific Timely Appointments for Triage (STAT) model, an alternative approach for managing access and triage, reduced waiting time by 34% in a stepped wedge cluster randomised controlled trial involving 8 services and more than 3000 participants. Follow up periods ranged from 3 to 10 months across the participating services in accordance with the stepped wedge design. This study aimed to determine whether outcomes were sustained for a full 12 months after implementation of the STAT model at each site.
Routinely collected service data were obtained for a total of 12 months following implementation of the STAT model at each of the 8 services that participated in a stepped wedge cluster randomised controlled trial. The primary outcome was time to first appointment. Secondary outcomes included non-attendance rates, time to second appointment and service use over 12 weeks. Outcomes were compared to pre-intervention data from the original trial, modelled using generalised linear mixed effects models accounting for clustering of sites.
A 29% reduction in waiting time could be attributed to STAT over 12 months, compared to 34% in the original trial. A reduction in variability in waiting time was sustained. There were no significant changes in time to second appointment or in the number of missed appointments in the extended follow up period.
STAT is an effective strategy for reducing waiting time in community-based outpatient services. At 12 months, small reductions in the overall effect are apparent, but reductions in variability are sustained, suggesting that people who previously waited the longest benefit most from the STAT model.
This is a 12-month follow up of a stepped wedge cluster randomised controlled trial that was registered with the Australia and New Zealand Clinical Trials Registry ( ACTRN12615001016527 ).
门诊和社区卫生服务提供者面临着及时就诊的挑战，因为管理需求的候诊名单往往很长。特定及时预约分诊（STAT）模型是一种管理就诊和分诊的替代方法，在一项涉及 8 个服务机构和 3000 多名参与者的阶梯式楔形集群随机对照试验中，将等候时间缩短了 34%。根据阶梯式楔形设计，参与服务机构的随访期从 3 到 10 个月不等。本研究旨在确定在每个站点实施 STAT 模型 12 个月后，结果是否能持续。
在 8 个参与阶梯式楔形集群随机对照试验的服务机构中，在实施 STAT 模型后的 12 个月内，收集了常规收集的服务数据。主要结果是首次预约的时间。次要结果包括未就诊率、第二次预约的时间和 12 周内的服务使用情况。将结果与原始试验的干预前数据进行比较，使用考虑站点聚类的广义线性混合效应模型进行建模。
与原始试验的 34%相比，STAT 在 12 个月内可将等待时间缩短 29%。等待时间的变异性得到了持续的降低。在延长的随访期间，第二次预约的时间或错过预约的次数没有明显变化。
STAT 是一种减少社区门诊服务等候时间的有效策略。在 12 个月时，总体效果的微小减少是明显的，但变异性的减少仍然持续，这表明以前等待时间最长的人从 STAT 模型中受益最大。
这是一项阶梯式楔形集群随机对照试验的 12 个月随访，该试验已在澳大利亚和新西兰临床试验注册中心（ACTRN12615001016527）注册。
