Smith Clifford A, Boden Matthew Tyler, Trafton Jodie A
VHA Office of Mental Health and Suicide Prevention.
Program Evaluation and Resource Center.
Psychol Serv. 2023 Feb;20(1):137-143. doi: 10.1037/ser0000449. Epub 2021 Nov 15.
Veterans Health Administration (VHA) continues to expand the mental health (MH) workforce to meet increasing demand for services. In the present study, longitudinal unbiased recursive partitioning models (conditional inference trees) were created to identify optimal cutoffs for outpatient staffing ratios associated with success on VHA's measures of quality, access, and satisfaction. Quarterly Staff-to-Patient Ratios (SPRs), defined as the number of full-time equivalent providers per 1,000 veterans receiving outpatient mental health care, were calculated for 12 quarters from fiscal years 2016-2018. Associations between VHA metrics associated with quality, access, and satisfaction were evaluated in relation to the overall outpatient SPR. The root node identified an overall outpatient SPR of 7.39 as the split for optimal MH performance. Root nodes associated with metrics addressing population coverage, continuity of care, and experience of care identified SPRs of 7.87, 6.81, and 7.42, respectively. In all analyses, the lowest SPRs were associated with the lowest performance on VHA MH metrics, while the highest SPRs were associated with the highest performance. Analyses support VHA's current recommended minimum outpatient SPR of 7.72 as a reasonable target to provide high-quality care, access, and satisfaction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
退伍军人健康管理局（VHA）继续扩大心理健康（MH）工作人员队伍，以满足不断增长的服务需求。在本研究中，创建了纵向无偏递归划分模型（条件推断树），以确定与VHA的质量、可及性和满意度指标成功相关的门诊人员配备比率的最佳临界值。计算了2016财年至2018财年12个季度的季度医患比率（SPR），定义为每1000名接受门诊心理健康护理的退伍军人中全职等效提供者的数量。评估了与质量、可及性和满意度相关的VHA指标与总体门诊SPR之间的关联。根节点确定总体门诊SPR为7.39作为最佳MH绩效的分割点。与人口覆盖、护理连续性和护理体验指标相关的根节点分别确定SPR为7.87、6.81和7.42。在所有分析中，最低的SPR与VHA MH指标的最低绩效相关，而最高的SPR与最高绩效相关。分析支持VHA目前建议的最低门诊SPR为7.72，作为提供高质量护理、可及性和满意度的合理目标。（PsycInfo数据库记录（c）2023美国心理学会，保留所有权利）
