Fitzhugh Mullan Institute for Health Workforce Equity, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC.
George Washington University School of Nursing, Washington, DC.
Fam Med. 2021 Sep;53(8):689-696. doi: 10.22454/FamMed.2021.843335.
Community-based residency programs are an important strategy to address rural and underserved primary care shortages, however, health centers report both benefits and challenges to training. This study aims to understand the impact of new Teaching Health Center (THC) residency programs on health center staffing, patient service, quality of care, and provider productivity.
Using the Uniform Data System, we used inverse propensity score weighting to create a balanced sample of new THC and non-THC health centers in 2010. Using 2018 data, we applied propensity score weighted regressions to examine changes in staffing, service, quality of care, and productivity in THC versus non-THC health centers.
In 2018, health centers with new THC programs were associated with increased physician (16.40, P<.01) staffing, yet decreased physician visits per full-time equivalent (-425.3, P<.01) relative to non-THC centers. New THC centers had increased delivery visits (231.0, P<.05), and had a greater rate of early entry into prenatal care (4.90%, P<.01).
New residency programs are associated with increased provider recruitment, expanded patient service, and some improved health outcomes, but also with potential decreased provider productivity in health centers.
以社区为基础的住院医师培训计划是解决农村和服务不足地区初级保健短缺的重要策略，然而，医疗中心在培训方面既报告了收益，也报告了挑战。本研究旨在了解新的教学医疗中心（THC）住院医师培训计划对医疗中心人员配备、患者服务、护理质量和提供者生产力的影响。
我们使用统一数据系统，通过逆倾向评分加权，在 2010 年创建了一个新的 THC 和非 THC 医疗中心的平衡样本。使用 2018 年的数据，我们应用倾向评分加权回归来检查 THC 与非 THC 医疗中心在人员配备、服务、护理质量和生产力方面的变化。
在 2018 年，拥有新 THC 项目的医疗中心与医生（16.40，P<.01）人员配备的增加有关，但与非 THC 中心相比，医生就诊次数每全职当量减少（-425.3，P<.01）。新 THC 中心的分娩就诊次数增加（231.0，P<.05），并且更早进入产前保健的比例更高（4.90%，P<.01）。
新的住院医师培训计划与提供者招聘的增加、患者服务的扩大以及一些健康结果的改善有关，但也可能导致医疗中心提供者生产力的下降。
