The Use of Enhanced Appointment Access Strategies by Medical Practices.
The Use of Enhanced Appointment Access Strategies by Medical Practices.
复制标题
医疗实践增强预约访问策略的使用。
DOI：
10.1097/mlr.0000000000000527
复制
发表时间：
2016
期刊：
影响因子：
3
通讯作者：
Shortell,StephenM
中科院分区：
文献类型：
--
作者：
Rodriguez,HectorP;Knox,Margae;Hurley,Vanessa;Rittenhouse,DianeR;Shortell,StephenM
背景：战略，以提高预约访问正在通过医疗实践的一部分，以病人为中心的医疗之家（PCMH）的实施，但鲜为人知的是，这些战略的使用national.Objectives：我们研究的做法使用开放访问调度和after hours care.Research Design：数据进行了分析，从第三次全国研究的医生组织（NSPO3），以检查增强预约访问策略更有可能被使用的做法，更强大的PCMH的能力和更大的外部激励。Logistic回归估计的效果PCMH的能力和外部激励措施的实践使用的开放获取调度和after hours care.Subjects：医师组织与> 20%的初级保健医生（n= 1106）。措施：PCMH的能力，包括团队为基础的护理，健康信息技术能力，质量改进的方向，和患者体验的方向。外部激励措施包括公开报告，按业绩付费（P4P），和负责任的护理组织participation.Results：一个低比例的做法（19.8%）使用同一天的开放访问调度，而下班后的护理（56.1%）是更常见的。在调整后的分析中，系统拥有的做法和更多地使用基于团队的护理，卫生信息技术能力和公共报告的做法更有可能使用开放获取调度。问责保健组织附属的做法和做法，更多地使用公共报告和P4P更有可能提供下班后care.Conclusions：开放访问调度可能是最有效地实施了强大的PCMH功能的做法。外部激励因素似乎会影响下班后护理的做法。扩大开放获取调度和下班后护理将需要不同的政策和支持。
Background:Strategies to enhance appointment access are being adopted by medical practices as part of patient-centered medical home (PCMH) implementation, but little is known about the use of these strategies nationally.Objectives:We examine practice use of open access scheduling and after-hours care.Research Design:Data were analyzed from the Third National Study of Physician Organizations (NSPO3) to examine which enhanced appointment access strategies are more likely to be used by practices with more robust PCMH capabilities and with greater external incentives. Logistic regression estimated the effect of PCMH capabilities and external incentives on practice use of open access scheduling and after-hours care.Subjects:Physician organizations with> 20% primary care physicians (n= 1106).Measures:PCMH capabilities included team-based care, health information technology capabilities, quality improvement orientation, and patient experience orientation. External incentives included public reporting, pay-for-performance (P4P), and accountable care organization participation.Results:A low percentage of practices (19.8%) used same-day open access scheduling, while after-hours care (56.1%) was more common. In adjusted analyses, system-owned practices and practices with greater use of team-based care, health information technology capabilities, and public reporting were more likely to use open access scheduling. Accountable care organization–affiliated practices and practices with greater use of public reporting and P4P were more likely to provide after-hours care.Conclusions:Open access scheduling may be most effectively implemented by practices with robust PCMH capabilities. External incentives appear to influence practice adoption of after-hours care. Expanding open access scheduling and after-hours care will require distinct policies and supports.