明确主要在养老院执业的医师的角色和价值：养老院医师的观点。
Defining the Role and Value of Physicians Who Primarily Practice in Nursing Homes: Perspectives of Nursing Home Physicians.
机构信息
Weill Cornell Medical College, Department of Population Health Sciences, New York, NY, USA.
Weill Cornell Medical College, Department of Population Health Sciences, New York, NY, USA.
出版信息
J Am Med Dir Assoc. 2022 Jun;23(6):962-967.e2. doi: 10.1016/j.jamda.2022.03.008. Epub 2022 Apr 13.
OBJECTIVE
To identify the perceptions of physicians with expertise in nursing home care on the value of physicians who primarily practice in nursing homes, often referred to as "SNFists," with the goal of enriching our understanding of specialization in nursing home care.
DESIGN
Qualitative analysis of semistructured interviews.
SETTING AND PARTICIPANTS
Virtual interviews conducted January 18-29, 2021. Participants included 35 physicians across the United States, who currently or previously served as medical directors or attending physicians in nursing homes.
METHODS
Interviews were conducted virtually on Zoom and professionally transcribed. Outcomes were themes resulting from thematic analysis.
RESULTS
Participants had a mean 19.5 (SD = 11.3) years of experience working in nursing homes; 17 (48.6%) were female; the most common medical specializations were geriatrics (18; 51.4%), family medicine (8; 22.9%), internal medicine (7; 20.0%), physiatry (1; 2.9%), and pulmonology (1; 2.9%). Ten (28.6%) participants were SNFists. We identified 6 themes emphasized by participants: (1) An unclear definition and loose qualifications for SNFists may affect the quality of care; (2) Specific competencies are needed to be a "good SNFist"; (3) SNFists are distinguished by their unique practice approach and often provide services that are unbillable or underreimbursed; (4) SNFists achieve better outcomes, but opinions varied on performance measures; (5) SNFists may contribute to discontinuity of care; (6) SNFists remained in nursing homes during the COVID-19 pandemic.
CONCLUSIONS AND IMPLICATIONS
There is a strong consensus among physicians with expertise in nursing home care that SNFists provide higher quality care for residents than other physicians. However, a uniform definition of a SNFist based on competencies in addition to standardized performance measures are needed. Unbillable and underreimbursed services create disincentives to physicians becoming SNFists. Policy makers may consider modifying Medicare reimbursements to incentivize more physicians to specialize in nursing home care.
目的
确定具有长期护理院专业知识的医生对主要在护理院执业的医生（通常称为“SNFist”）的价值的看法，旨在丰富我们对护理院专业知识的理解。
设计
半结构化访谈的定性分析。
地点和参与者
2021 年 1 月 18 日至 29 日进行虚拟访谈。参与者包括美国各地的 35 名医生，他们目前或之前担任过养老院的医疗主任或主治医生。
方法
通过 Zoom 进行虚拟访谈，并进行专业转录。结果是主题分析得出的主题。
结果
参与者在护理院工作的平均经验为 19.5 年（标准差=11.3）；17 名（48.6%）为女性；最常见的医学专业是老年医学（18；51.4%）、家庭医学（8；22.9%）、内科（7；20.0%）、物理医学（1；2.9%）和肺病学（1；2.9%）。有 10 名（28.6%）参与者是 SNFist。我们确定了参与者强调的 6 个主题：（1）SNFist 的定义不明确，资格要求宽松，可能影响护理质量；（2）需要特定的能力才能成为“优秀的 SNFist”；（3）SNFist 以其独特的实践方法为特征，并且经常提供无法计费或报销不足的服务；（4）SNFist 取得了更好的结果，但对绩效评估方法的看法不一；（5）SNFist 可能导致护理连续性中断；（6）SNFist 在 COVID-19 大流行期间留在护理院。
结论和影响
具有长期护理院专业知识的医生普遍认为，SNFist 为居民提供的护理质量高于其他医生。然而，需要根据能力和标准化的绩效评估方法为 SNFist 制定统一的定义。无法计费和报销不足的服务使医生成为 SNFist 的动力不足。政策制定者可能会考虑修改医疗保险报销，以激励更多医生专门从事护理院护理。
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