Jt Comm J Qual Patient Saf. 2021 Mar;47(3):190-197. doi: 10.1016/j.jcjq.2020.10.004. Epub 2020 Oct 24.
Delay in primary care access for new patients to US Department of Veterans Affairs (VA) health care services has been a persistent problem. This article presents the evaluation of a quality improvement (QI) intervention that provided new patients with same-day primary care access. It involved redesign of an intake clinic (IC) through which new patients were initially seen and referred to primary care. The redesign included changes in clinic flow and reallocation of two full-time primary care providers (PCPs) from IC to their primary care teams.
A pre-post retrospective study evaluating a QI intervention at a VA hospital examined 22,220 administrative patient records. Specifically, 9,909 new patients seen in the three years prior to implementation of VA-HONORS (preintervention group) were compared with 12,311 patients seen in the three years after implementation (postintervention group). Study outcomes were (1) number of days to first appointment with PCP, (2) proportion of patients receiving same-day primary care access, and (3) visit cycle time.
Preintervention, median first primary care appointment delay was 96 days, compared to 0 days postintervention (p < 0.001). Preintervention, 3.1% of new patients were able to obtain same-day primary care appointment, compared with 91.5% postintervention (p < 0.001). Median visit cycle time was 140 minutes preintervention vs. 148 minutes postintervention (p < 0.001).
New patients' same-day access system redesign at one VA hospital dramatically eliminated first primary care appointment delay. The redesign was feasible and sustainable for a sizable population and serves as a model for similar settings with new patients' primary care access delay.
新患者在美国退伍军人事务部（VA）医疗保健服务中获得初级保健的延迟一直是一个持续存在的问题。本文介绍了一项质量改进（QI）干预措施的评估，该措施为新患者提供了当天的初级保健服务。它涉及通过最初接待和转介新患者的初级保健的摄入诊所（IC）进行重新设计。重新设计包括改变诊所流程和将两名全职初级保健提供者（PCP）从 IC 重新分配到他们的初级保健团队。
一项在 VA 医院评估 QI 干预措施的前后回顾性研究，评估了 22220 份行政患者记录。具体来说，在实施 VA-HONORS 之前的三年中，有 9909 名新患者接受了治疗（干预前组），而在实施后的三年中，有 12311 名新患者接受了治疗（干预后组）。研究结果为：（1）与 PCP 的首次预约天数，（2）获得当天初级保健服务的患者比例，和（3）就诊周期时间。
在干预前，首次初级保健预约的中位数延迟为 96 天，而在干预后为 0 天（p < 0.001）。在干预前，只有 3.1%的新患者能够获得当天的初级保健预约，而在干预后，有 91.5%的新患者能够获得当天的初级保健预约（p < 0.001）。干预前的就诊周期中位数为 140 分钟，而干预后的就诊周期中位数为 148 分钟（p < 0.001）。
VA 医院新患者当日就诊系统的重新设计极大地消除了首次初级保健预约的延迟。重新设计对于相当数量的患者来说是可行且可持续的，并为其他新患者初级保健就诊延迟的类似环境提供了一个模式。
