Coleman Jennifer A, Werner Brianna, Klassen Brian J, Smith Dale L, Banerjee Uddyalok, Held Philip
Department of Psychiatry, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 602, Chicago, IL, 60612, USA.
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
J Behav Health Serv Res. 2025 Apr;52(2):342-356. doi: 10.1007/s11414-024-09920-4. Epub 2024 Dec 17.
The Institute of Medicine (2001) describes quality health care as safe, effective, patient-centered, efficient, equitable, and timely. Although this definition highlights the necessity of continuous program evaluation to ensure that these goals are being addressed, there is a notable lack of industry-wide standards and benchmarks, and many clinical programs lack the ability to continually and rigorously evaluate their own performance with data. This might be particularly true in the case of ensuring service members and veterans with posttraumatic stress disorder (PTSD) obtain treatment, as several systemic barriers exist, such as long wait times and lack of equitable treatment for individuals with minoritized identities. The current study examines the impact of a clinic-wide intake redesign for a massed PTSD treatment program to shift the intake process to a small, dedicated team rather than a responsibility shared across all clinicians. The redesign led to significantly shorter wait times for treatment and reduced some types of pre-treatment dropout. On average, patients received an acceptance/rejection decision 1 week sooner, attended the program almost 2 months sooner, and saw a roughly 60% reduction in the odds of dropout at the point of receiving an acceptance/rejection decision. Some disparities in wait times for those who were not partnered, women, and individuals who financially supported more family members remained after the redesign. Results are discussed in light of the importance of continuous program evaluation to address IOM's holistic definition of quality health care.
美国医学研究所（2001年）将优质医疗保健描述为安全、有效、以患者为中心、高效、公平且及时的。尽管这一定义强调了持续进行项目评估以确保实现这些目标的必要性，但行业范围内的标准和基准明显缺失，而且许多临床项目缺乏利用数据持续且严格评估自身表现的能力。在确保创伤后应激障碍（PTSD）患者和退伍军人获得治疗方面可能尤其如此，因为存在一些系统性障碍，比如等待时间过长以及对少数族裔身份个体缺乏公平治疗。本研究考察了针对大规模PTSD治疗项目进行的全诊所接诊流程重新设计的影响，即将接诊流程转移至一个小型的专门团队，而非由所有临床医生共同负责。重新设计显著缩短了治疗等待时间，并减少了某些类型的治疗前退出情况。平均而言，患者收到接受/拒绝决定的时间提前了1周，参加项目的时间提前了近2个月，并且在收到接受/拒绝决定时退出几率大约降低了60%。重新设计后，未成家者、女性以及经济上供养更多家庭成员者在等待时间上仍存在一些差异。根据持续项目评估对于实现美国医学研究所对优质医疗保健的整体定义的重要性对结果进行了讨论。
