Developing a New Method to Improve Primary Care Workforce Management

开发改进初级保健劳动力管理的新方法

• 批准号: 10425164
• 负责人: KARIN M. NELSON
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425164
• 关键词: Address; Caring; Charge; Chronic Disease; Clinic; Complex; Data; Disease Management; Ensure; Equilibrium; Event; Exhibits; Foundations; Funding; Future; Goals; Health Personnel; Healthcare Systems; Home; Hour; Integrated Health Care Systems; Measures; Medical; Methodology; Methods; Modeling; Natural experiment; Nature; Nurse Practitioners; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Persons; Physician Assistants; Pilot Projects; Policies; Preventive service; Primary Care Physician; Primary Health Care; Probability; Process; Productivity; Program Evaluation; Provider; Publishing; Randomized; Recording of previous events; Reporting; Research; Secure; Services; Shock; Specialist; System; Telemedicine; Telephone; Testing; Thinness; Time; Transact; United States Department of Veterans Affairs; Update; Variant; Veterans; Visit; Work; Workload; acute care; adverse outcome; base; burnout; care coordination; care providers; contextual factors; evidence base; handbook; improved; innovation; insight; intervention program; meetings; novel; pandemic coronavirus; patient population; primary care services; programs; sound; time use; tool; video visit

Background: The Office of Primary Care (OPC) is charged with overseeing primary care in the Department of Veterans Affairs (VA). In 2010, VA primary care moved to a medical home model called the Patient Aligned Care Team (PACT). Over 5.7 million Veterans are assigned, or “empaneled”, to a primary care provider and team. Current VA panel sizes are based on historic means and there are concerns that these metrics should be updated given high rates of burnout among primary care providers. However, the evidence base is thin, and a recent a recent HSR&D Evidence Synthesis Program (ESP) report calls for greater evidence to manage the primary care work force of 7,995 primary care physicians and providers (PCP). Significance/Impact: This study will assist the VA with managing its primary care workforce to balance the needs for efficiency and the wellness of the workforce. The novel methods in this study will set the stage for future randomized program evaluations that can test ways to improve efficiency and outcomes for providers and patients. Innovation: The goal of the proposed study is to provide foundational evidence on primary care panel size by adapting and extending a recently developed methodology to assess the workload of primary care patients. The results of this study have a high probability of immediate impact in the VA by informing primary care work force management, in addition to providing evidence that longitudinal patient histories can be used to estimate time and workload for primary care panels. Specific Aims: Aim 1: To describe weekly demand, weekly capacity, and weekly overflow (i.e., demand > capacity) for every PCP and how these parameters vary by PCP, by team, by clinic and by health care system. Aim 2: To determine whether system-level funding is associated with PCP overflow. We will examine the association between the system funding and PCP overflow. Aim 3: To identify which patient events are leading to overflow. This aim examines random variation in weekly patient flow to determine whether random “shocks” in patient events are leading to overflow. Aim 4: To examine overflow in relation to workforce health, measured by provider burnout and turnover. Methodology: The proposed study extends a recently developed methodology to assess the workload of primary care patients and use this workload to develop time estimates for caring for populations of patients. This approach, recently published by Rossi et al. (2018), uses longitudinal data to enumerate patient-related events, or transactions, including both face to face visits and non-face to face care. These transactions are then combined with time estimates per transaction to determine the time it would take to care for a panel of patients. The method provides information on the flow of patients and the demand on primary care providers, and allows for calculation of overflow, where demand would exceed capacity to supply services. We have piloted this method in one health care system in VA and have demonstrated the feasibility of using this method for VA data and have calculated plausible estimates for overflow hours. Implementation/Next steps: The current proposal builds a methodology for tracking panel management. These results have implications for primary care workforce management in VA and other large integrated health systems. It will be through future randomized program evaluations, in combination with the tools we are building, that we will be able to understand the causal effects of policies on PCP productivity, while tracking adverse outcomes.

背景：初级保健办公室（OPC）被控监督部门的初级保健 退伍军人事务（VA）。 2010年，VA初级保健转移到了一个名为患者对齐的医疗家庭模型 护理团队（PACT）。将超过570万的退伍军人分配给或“授权”给初级保健提供者和 团队。当前的VA面板尺寸基于历史手段，并且有人担心这些指标应 鉴于初级保健提供者的倦怠率很高，因此可以更新。但是，证据基础很薄，并且 最近的HSR＆D证据综合计划（ESP）报告要求提供更多的证据来管理 7,995家初级保健医师和提供者（PCP）的初级保健劳动力。 意义/影响：本研究将帮助VA管理其初级保健员工，以平衡 效率和劳动力健康的需求。这项研究中的新方法将为 未来的随机计划评估，可以测试提高效率和结果的方法 和患者。 创新：拟议研究的目的是通过 适应并扩展了最近开发的方法来评估初级保健患者的工作量。 这项研究的结果通过告知初级保健工作，对VA有很高的直接影响。 除了提供纵向患者历史的证据外，力量管理还可以用于估计 初级保健面板的时间和工作量。 具体目的：目标1：描述每周需求，每周容量和每周溢出（即需求> 每个PCP的容量）以及这些参数如何因PCP，团队，诊所和医疗保健系统而异。 AIM 2：确定系统级资金是否与PCP溢出有关。我们将检查 系统资金与PCP溢出之间的关联。目标3：确定哪些患者事件是 导致溢出。此目标检查每周患者流动的随机变化，以确定是否随机 患者事件中的“冲击”导致溢出。目标4：检查与劳动力健康有关的溢出， 通过提供商的倦怠和营业额来衡量。 方法论：拟议的研究扩展了最近开发的方法来评估工作量 初级保健患者并使用此工作量来制定照顾患者人群的时间估计。 这种方法，最近由Rossi等人发表。 （2018年），使用纵向数据列举与患者有关的 事件或交易，包括面对面的访问和非面对面的面对护理。这些交易是 然后结合每笔交易的时间估计，以确定要照顾一个面板所需的时间 患者。该方法提供了有关患者流动以及对初级保健提供者需求的信息， 并允许计算溢出，其中需求将超过提供服务的能力。我们有 在弗吉尼亚州的一个医疗保健系统中试用了这种方法，并证明了使用此方法的可行性 对于VA数据，并计算了溢流小时的合理估计值。 实施/下一步：当前的提案构建了一种跟踪面板管理的方法。 这些结果对VA和其他大型集成的初级保健劳动力管理有影响 卫生系统。它将通过未来的随机程序评估，并结合我们的工具 建筑物，我们将能够了解政策对PCP生产率的因果影响，同时跟踪 不利的结果。