国家退伍军人事务部医疗抄写员试点对心脏病学和骨科医生的生产力、等候时间和患者满意度的影响。
Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics.
机构信息
Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA.
Department of Health Law, Policy, and Management, Boston University, Boston, MA, USA.
出版信息
J Gen Intern Med. 2023 Jul;38(Suppl 3):878-886. doi: 10.1007/s11606-023-08114-6. Epub 2023 Jun 20.
BACKGROUND
Section 507 of the VA MISSION Act of 2018 mandated a 2-year pilot study of medical scribes in the Veterans Health Administration (VHA), with 12 VA Medical Centers randomly selected to receive scribes in their emergency departments or high wait time specialty clinics (cardiology and orthopedics). The pilot began on June 30, 2020, and ended on July 1, 2022.
OBJECTIVE
Our objective was to evaluate the impact of medical scribes on provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act.
DESIGN
Cluster randomized trial, with intent-to-treat analysis using difference-in-differences regression.
PATIENTS
Veterans using 18 included VA Medical Centers (12 intervention and 6 comparison sites).
INTERVENTION
Randomization into MISSION 507 medical scribe pilot.
MAIN MEASURES
Provider productivity, wait times, and patient satisfaction per clinic-pay period.
KEY RESULTS
Randomization into the scribe pilot was associated with increases of 25.2 relative value units (RVUs) per full-time equivalent (FTE) (p < 0.001) and 8.5 visits per FTE (p = 0.002) in cardiology and increases of 17.3 RVUs per FTE (p = 0.001) and 12.5 visits per FTE (p = 0.001) in orthopedics. We found that the scribe pilot was associated with a decrease of 8.5 days in request to appointment day wait times (p < 0.001) in orthopedics, driven by a 5.7-day decrease in appointment made to appointment day wait times (p < 0.001), and observed no change in wait times in cardiology. We also observed no declines in patient satisfaction with randomization into the scribe pilot.
CONCLUSIONS
Given the potential improvements in productivity and wait times with no change in patient satisfaction, our results suggest that scribes may be a useful tool to improve access to VHA care. However, participation in the pilot by sites and providers was voluntary, which could have implications for scalability and what effects could be expected if scribes were introduced to the care process without buy-in. Cost was not considered in this analysis but is an important factor for future implementation.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04154462.
背景
2018 年《退伍军人事务部使命法案》第 507 条授权在退伍军人健康管理局（VHA）进行为期两年的医疗书记员试点研究，随机选择 12 个 VA 医疗中心在急诊部门或高等待时间专科诊所（心脏病学和骨科）配备书记员。该试点于 2020 年 6 月 30 日开始，2022 年 7 月 1 日结束。
目的
根据《使命法案》的要求，我们的目标是评估医疗书记员对心脏病学和骨科中医生生产力、等待时间和患者满意度的影响。
设计
集群随机试验，使用差异中的差异回归进行意向治疗分析。
患者
使用 18 个纳入的 VA 医疗中心的退伍军人（12 个干预组和 6 个对照组）。
干预
随机分配到 MISSION 507 医疗书记员试点。
主要措施
每个诊所支付期的医生生产力、等待时间和患者满意度。
主要结果
参与书记员试点与心脏病学每全职等效（FTE）增加 25.2 相对价值单位（RVU）（p<0.001）和每 FTE 增加 8.5 次就诊（p=0.002）以及骨科每 FTE 增加 17.3 RVU（p=0.001）和每 FTE 增加 12.5 次就诊（p=0.001）相关。我们发现，书记员试点与骨科预约到预约日等待时间减少 8.5 天相关（p<0.001），这主要是由于预约到预约日等待时间减少了 5.7 天（p<0.001），而在心脏病学中观察到等待时间没有变化。我们还观察到，随机分配到书记员试点对患者满意度没有下降。
结论
鉴于生产力和等待时间的潜在改善，而患者满意度没有变化，我们的结果表明，书记员可能是改善退伍军人事务部护理获取的有用工具。然而，参与试点的站点和提供者是自愿的，这可能对可扩展性和如果没有得到认可就将书记员引入护理过程可能产生的影响产生影响。本分析未考虑成本，但这是未来实施的一个重要因素。
试验注册
ClinicalTrials.gov 标识符：NCT04154462。
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