Identifying Value-Driven Approaches to Strengthening the VA Physician Workforce

确定以价值驱动的方法来加强 VA 医生队伍

• 批准号: 10186500
• 负责人: Edwin S. Wong
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186500
• 关键词: Address; Affordable Care Act; Appointment; Area; Clinic; Clinical; Data; Data Analyses; Development; Economics; Elements; Employee; Employment; Employment Status; Ensure; Exposure to; Financial compensation; Geographic Locations; Goals; Health Personnel; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Home; Individual; Influentials; Internal Medicine; Interview; Knowledge; Link; Literature; Measures; Medical; Medical center; Methods; Modeling; Occupations; Patient Care; Physicians; Policies; Population; Positioning Attribute; Primary Care Physician; Primary Health Care; Probability; Process; Public Health; Reporting; Research; Retirement; Role; Running; Rural; Rural Health; Rural Health Centers; Salaries and Fringe Benefits; Sample Size; Sampling; Statistical Methods; Structure; Surveys; System; Time; Training; United States Department of Veterans Affairs; Variant; Veterans; Wages; Wait Time; administrative database; aging population; base; burden of illness; care systems; career; data resource; demographics; econometrics; evidence base; health care availability; improved; innovation; insight; interest; novel; patient oriented; practice setting; preference; primary care services; professional atmosphere; prospective; recruit; rural setting; secondary analysis

Background: Primary care physician (PCP) shortages are a significant and growing problem confronting the US healthcare system. An overall shortage of up to 53,000 PCPs is projected in the US by 2025, due in part to increased demand for primary care services because of an aging population, growing disease burden and a declining interest in primary care careers among medical residents. A shortage of PCPs in VA has recently come under increased focus due to the emphasis on improving Veterans’ access to high quality and timely healthcare. Providing timely access to primary care requires a sufficiently large PCP workforce. However, as of May 2016, VA was reported to have been trying to fill up to 500 PCP positions, reflecting roughly 12% of the current VA PCP workforce. Prior research has not examined several important individual, economic, job and system-level factors associated with the recruitment and retention of PCPs by health systems. These understudied factors include components of pay and compensation, academic affiliation, elements of the patient-centered medical home model and workplace climate, which represent areas where VA data offer unique contributions. In addition, no prior research has examined the relative importance of factors in explaining PCP recruitment and retention. Identifying and prioritizing key factors associated with PCPs’ employment choices will help VA and other health systems with the strategic recruitment of PCPs and the development of evidence-based strategies to retain high quality PCPs. Objectives: The objectives of this study are to: 1) identify and prioritize individual, job, economic and system- level factors associated with the choice of VA for employment and selection of rural practice (i.e. recruitment) using existing VA data as well as new qualitative and survey data collected for this study and 2) identify and prioritize individual, job, economic and system-level factors associated with long-run retention of PCPs within VA and in rural VA clinics using administrative data and existing survey data. Methods: This mixed methods study will examine VA administrative data, existing VA employee survey data, public health resource data and new qualitative and survey data collected for this project. To measure factors associated with VA recruitment and choice of rural practice setting (Aim 1), we will conduct structured interviews with current internal medicine residents exposed to VA settings during their training and new PCPs with a permanent VA position. We will then develop and administer a new survey instrument using key factors identified in qualitative interviews and factors of particular interest in this study. Triangulation will then be used to assess whether key factors and themes established in qualitative analyses generalize to the larger population of internal medicine residents and new VA PCPs. We will perform descriptive analyses to compare influential factors identified in interviews and surveys between residents and new PCPs. Multivariable analyses will be used to identify factors that are significantly associated with consideration of VA employment and rural practice among internal medicine residents. For Aim 2, we will use VA administrative databases to track the employment status of VA PCPs longitudinally. We will identify all PCPs assigned to a panel of primary care patients who met a minimum clinical full-time equivalent (FTE) threshold and were employed by VA at any time during the period 2003-2016. We will link administrative data with VA and public survey data to examine key factors of interest. Statistical methods for survival data analysis will be applied to assess the influence of hypothesized factors on quarterly retention probabilities and PCPs’ expected duration of VA employment. Parallel analyses will assess PCP retention in rural VA facilities. Secondary analyses will examine the longitudinal profile of clinical FTE using an extended two-part model. In both aims, we will apply econometric methods including Shapley value decompositions to partition the variation in PCP recruitment and retention explained by key explanatory factors and factor combinations.

背景：初级保健物理（PCP）短缺是一个重大且越来越多的问题 美国医疗保健系统。到2025年，美国预计的总体短缺将在美国预计，部分原因是 由于人口老龄化，疾病伯恩伯恩和a的需求增加了对初级保健服务的需求 医疗居民对初级保健职业的兴趣下降。 VA中的PCP短缺最近 由于强调改善退伍军人获得高质量和及时的重点，因此越来越重视 卫生保健。提供及时获得初级保健需要足够大的PCP劳动力。但是，到底 2016年5月，据报道，VA试图填补多达500个PCP职位，大约反映了约12％ 当前的VA PCP劳动力。先前的研究尚未检查几个重要的个人，经济，工作和 与卫生系统招募和保留PCP相关的系统级因素。这些 研究的因素包括工资和薪酬的组成部分，学术分支机构， 以患者为中心的医疗家庭模型和工作场所气候，这代表了VA数据提供的区域 独特的贡献。此外，没有先前的研究研究了因素在 解释PCP招聘和保留。识别和确定与PCP相关的关键因素 就业选择将有助于VA和其他卫生系统进行PCP的战略招募和 制定基于证据的策略来保留高质量的PCP。 目标：本研究的目标是：1）确定并确定个人，工作，经济和系统 - 与选择为就业和选择农村实践的VA选择相关的级别因素（即招聘） 使用现有的VA数据以及本研究收集的新定性和调查数据，2）识别和 优先考虑与长期保留PCP相关的个人，工作，经济和系统级别的因素 VA和粗糙的VA诊所使用管理数据和现有调查数据。 方法：此混合方法研究将检查VA管理数据，现有的VA员工调查数据， 为该项目收集的公共卫生资源数据以及新的定性和调查数据。衡量因素 与VA招聘和农村实践设置的选择相关（AIM 1），我们将进行结构化 在培训期间与现有内科居民接触到VA设置的访谈和新的PCP 具有永久的VA位置。然后，我们将使用关键因素开发和管理新的调查工具 在定性访谈和本研究中特别感兴趣的因素中确定。然后将使用三角剖分 评估定性分析中建立的关键因素和主题是否概括为较大 内科居民和新的VA PCP的人口。我们将进行描述性分析以比较 居民与新PCP之间的访谈和调查中确定的影响因素。多变量分析 将用于识别与VA就业和农村有关的因素显着相关的因素 在内科居民中练习。对于AIM 2，我们将使用VA管理数据库来跟踪 VA PCP的就业状况纵向。我们将确定分配给初级保健面板的所有PCP 遇到最低临床全日制等效（FTE）阈值并随时使用VA的患者 在2003 - 2016年期间。我们将将管理数据与VA和公共调查数据联系起来，以检查密钥 感兴趣的因素。将应用用于生存数据分析的统计方法来评估 关于季度保留可能性和PCP的预期VA就业持续时间的假设因素。 并行分析将评估弗吉尼亚州农村设施中的PCP保留率。次级分析将检查 使用扩展的两部分模型对临床FTE的纵向轮廓。在这两个目标中，我们都将应用经济 包括沙普利价值分解的方法，以分区PCP募集和保留的变化 用关键的拔出因素和因子组合解释。