采用强化管理项目能否改善基层医疗人员护理高危患者的体验？
Can Using an Intensive Management Program Improve Primary Care Staff Experiences With Caring for High-Risk Patients?
作者信息
Meredith Lisa S, Azhar Gulrez, Chang Evelyn T, Okunogbe Adeyemi, Simon Alissa, Han Bing, Rubenstein Lisa V
机构信息
is a Senior Behavioral Scientist at the RAND Corporation, Professor, Pardee RAND Graduate School, and Research Scientist at the VA Center for the Study of Healthcare Innovation, Implementation & Policy in Santa Monica, California. is a Senior Fellow, Futures Health Scenarios at the Institute for Health Metrics and Evaluation, University of Washington and an Adjunct Policy Researcher at RAND. is a Primary Care Physician and Health Services Researcher at VA Greater Los Angeles Health System (VAGLAHS) and an Assistant Clinical Professor in Health Sciences at University of California in Los Angeles (UCLA). is a Health Systems Specialist at RTI International, Washington, DC. is a Health Science Specialist at the VAGLAHS. is a Senior Statistician at the RAND Corporation in Santa Monica, California. is Professor Emeritus at UCLA Geffen School of Medicine and UCLA Fielding School of Public Health, and Physician Policy Researcher at RAND.
出版信息
Fed Pract. 2021 Feb;38(2):68-73. doi: 10.12788/fp.0090.
BACKGROUND
Complex, high-risk patients present challenges for primary care staff. Intensive outpatient management teams aim to serve as a resource for usual primary care to improve care for high-risk patients without adding burden to the primary care staff. Whether such assistance can influence the primary care staff experiences is unknown. The objective of this study was to examine improvement in job satisfaction and intent to stay for primary care staff at the US Department of Veterans Affairs (VA) who sought assistance from an intensive management program.
METHODS
Longitudinal analysis of a staff cohort that completed 2 cross-sectional surveys 18 months apart, controlling for outcomes at time 1. Participants included 144 primary care providers at 5 geographically diverse VA health care systems who completed both surveys. Measured outcomes included job satisfaction and intent to stay within primary care at the VA (measured at time 2). Predictors included likelihood of using intensive management teams (measured at time 1). Covariates included outcomes and professional/practice characteristics (measured at time 1).
RESULTS
The response rate for primary care staff that completed both surveys was 21%. Staff who indicated at time 1 that they were more likely to use intensive management teams for high-risk patients reported significantly higher satisfaction and intention to stay at VA primary care at time 2 (both < .05).
CONCLUSIONS
A VA primary care workforce might benefit from assistance from intensive management teams for high-risk patients. Additional work is needed to understand the mechanisms by which primary care staff benefit and how to optimize them.
背景
复杂的高危患者给基层医疗人员带来了挑战。强化门诊管理团队旨在作为常规基层医疗的一种资源，以改善对高危患者的护理，同时不给基层医疗人员增加负担。这种协助是否会影响基层医疗人员的体验尚不清楚。本研究的目的是检验美国退伍军人事务部（VA）中寻求强化管理项目协助的基层医疗人员的工作满意度和留任意向的改善情况。
方法
对一个工作人员队列进行纵向分析，该队列相隔18个月完成了两次横断面调查，并对第1阶段的结果进行控制。参与者包括来自5个地理位置不同的VA医疗系统的144名基层医疗提供者，他们完成了两次调查。测量的结果包括工作满意度和留在VA基层医疗岗位的意向（在第2阶段测量）。预测因素包括使用强化管理团队的可能性（在第1阶段测量）。协变量包括结果以及专业/实践特征（在第1阶段测量）。
结果
完成两次调查的基层医疗人员的回复率为21%。在第1阶段表示更有可能为高危患者使用强化管理团队的工作人员在第2阶段报告的满意度和留在VA基层医疗岗位的意向显著更高（均P<0.05）。
结论
VA基层医疗工作人员可能会从针对高危患者的强化管理团队的协助中受益。需要进一步开展工作以了解基层医疗人员受益的机制以及如何对其进行优化。
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