安大略省卫生系统领导人对管理 COVID-19 择期手术积压的单一入口模型的看法：一项解释性描述性研究。
Perceptions of Ontario health system leaders on single-entry models for managing the COVID-19 elective surgery backlog: an interpretive descriptive study.
机构信息
Temerty Faculty of Medicine (Shapiro, Axelrod, Levy), University of Toronto; Department of Health Policy, Management and Evaluation (Shapiro, Levy, Sriharan, Urbach, Bhattacharyya), University of Toronto; Department of Family and Community Medicine (Bhattacharyya), University of Toronto; Department of Family Medicine and Women's College Research Institute (Bhattacharyya), Women's College Hospital; Department of Surgery, Temerty Faculty of Medicine (Urbach), University of Toronto; Department of Surgery and Women's College Research Institute (Urbach), Women's College Hospital, Toronto, Ont.
出版信息
CMAJ Open. 2022 Aug 30;10(3):E789-E797. doi: 10.9778/cmajo.20210234. Print 2022 Jul-Sep.
BACKGROUND
The COVID-19 pandemic has exacerbated pre-existing challenges with respect to access to elective surgery across Canada, and a single-entry model (SEM) approach has been proposed as an equitable and efficient method to help manage the backlog. With Ontario's recent investment in centralized surgical wait-list management, we sought to understand the views of health system leaders on the role of SEMs in managing the elective surgery backlog.
METHODS
We used the qualitative method of interpretive description to explore participant perspectives and identify practical strategies for policy-makers, administrators and clinical leaders. We conducted semistructured interviews with health system leaders from across Ontario on Zoom between March and June 2021. We used snowball and purposive sampling. Inclusion criteria included Ontario health care leaders, fluent in English or French, in positions relevant to managing the elective surgery backlog. Exclusion criteria were individuals who work outside Ontario, or do not hold relevant roles.
RESULTS
Our interviews with 10 health system leaders - including hospital chief executive officers, surgeons, administrators and policy experts - resulted in 5 emergent domains: perceptions of the backlog, operationalizing and financing SEMs, barriers, facilitators, and equity and patient factors. All participants emphasized the need for clinical leaders to champion SEMs and the utility of SEMs in managing wait-lists for high-volume, low-acuity, low-complexity and low-variation surgeries.
INTERPRETATION
Although SEMs are no panacea, the participants in our study stated that they believe SEMs can improve quality and reduce variability in wait times when SEMs are designed to address local needs and are implemented with buy-in from champions. Health care leaders should consider SEMs for improving surgical backlog management in their local jurisdictions.
背景
COVID-19 大流行加剧了加拿大各地获得择期手术的机会所面临的先前存在的挑战，并且提出了单入口模型 (SEM) 方法作为帮助管理积压的公平和有效的方法。随着安大略省最近对集中手术等候名单管理的投资，我们试图了解卫生系统领导人对 SEM 在管理择期手术积压方面的作用的看法。
方法
我们使用解释性描述的定性方法来探讨参与者的观点，并为政策制定者、管理人员和临床领导者确定实用策略。我们在 2021 年 3 月至 6 月期间通过 Zoom 对安大略省各地的卫生系统领导人进行了半结构化访谈。我们使用了滚雪球和有针对性的抽样。纳入标准包括以英语或法语为母语、在与管理择期手术积压相关的职位上的安大略省卫生保健领导人。排除标准是在安大略省以外工作或不担任相关职务的个人。
结果
我们对 10 名卫生系统领导人的采访，包括医院首席执行官、外科医生、管理人员和政策专家，得出了 5 个新兴领域：对积压的看法、SEM 的运作和融资、障碍、促进因素以及公平和患者因素。所有参与者都强调临床领导者需要支持 SEM，并认为 SEM 有助于管理高容量、低紧急性、低复杂性和低变异性手术的等候名单。
解释
尽管 SEM 不是万能的，但我们研究中的参与者表示，他们认为 SEM 可以在设计旨在满足当地需求并获得拥护者认可的情况下提高质量并减少等待时间的可变性。卫生保健领导人应考虑在其当地司法管辖区内使用 SEM 来改善手术积压管理。
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