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: 9691048
• 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/9691048
• 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 environment; 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; 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：初级保健医生（PCP）短缺是医疗保健面临的一个重大且日益严重的问题。 美国医疗保健系统预计到 2025 年，PCP 总数将短缺多达 53,000 名，部分原因是 由于人口老龄化、疾病负担增加以及疾病负担增加，对初级保健服务的需求增加 住院医生对初级保健职业的兴趣下降，最近退伍军人事务部的 PCP 短缺。 由于强调提高退伍军人获得高质量和及时服务的机会，因此受到越来越多的关注 提供及时的初级保健服务需要足够多的 PCP 劳动力。 2016 年 5 月，据报道 VA 一直在试图填补多达 500 个 PCP 职位，约占 12% 目前的 VA PCP 劳动力队伍之前的研究并未考察几个重要的个人、经济、工作和情况。 与卫生系统招募和保留 PCP 相关的系统层面因素。 未被充分研究的因素包括薪资和报酬的组成部分、学术背景、 以患者为中心的医疗之家模式和工作场所氛围，代表 VA 数据提供的领域 此外，之前没有研究考察过这些因素的相对重要性。 解释与 PCP 相关的关键因素的招募和保留。 就业选择将有助于 VA 和其他卫生系统战略性招募 PCP 和 制定循证策略以保留高质量的 PCP。 目标：本研究的目标是：1）确定个人、工作、经济和系统并确定优先顺序- 与选择 VA 就业和选择农村实践（即招聘）相关的水平因素 使用现有的 VA 数据以及为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、经济和系统层面的因素 VA 和农村 VA 诊所使用行政数据和现有调查数据。 方法：这项混合方法研究将检查 VA 行政数据、现有 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来衡量因素。 与 VA 招募和农村实践环境选择（目标 1）相关，我们将进行结构化的 对在培训期间接触过 VA 环境的现有内科医生和新 PCP 进行采访 然后，我们将使用关键因素开发和管理新的调查工具。 然后将使用在定性访谈中确定的以及本研究中特别感兴趣的因素。 评估定性分析中建立的关键因素和主题是否可以推广到更大范围 我们将进行描述性分析来比较内科住院医师和新的 VA PCP。 在居民和新 PCP 之间的访谈和调查中确定的影响因素。 将用于确定与考虑 VA 就业和农村地区显着相关的因素 对于目标 2，我们将使用 VA 管理数据库来跟踪内科住院医师的实践情况。 VA PCP 的纵向就业状况 我们将确定分配给初级保健小组的所有 PCP。 满足最低临床全职当量 (FTE) 阈值并随时受 VA 雇用的患者 2003-2016 年期间，我们将把行政数据与 VA 和公共调查数据联系起来，以检查关键数据。 将应用生存数据分析的统计方法来评估以下因素的影响。 探讨了季度保留概率和 PCP 的 VA 就业预期持续时间的因素。 平行分析将评估农村 VA 设施中 PCP 的保留情况。 使用扩展的两部分模型的临床 FTE 的纵向概况 在这两个目标中，我们将应用计量经济学。 包括 Shapley 值分解在内的方法来划分 PCP 招募和保留的变化 通过关键解释因素和因素组合来解释。