Modernizing operations to improve efficiency and refine the role and mission of sexually transmitted infection clinics.
Modernizing operations to improve efficiency and refine the role and mission of sexually transmitted infection clinics.
复制标题
实现运营现代化，以提高效率并完善性传播感染诊所的作用和使命。
DOI：
10.1097/olq.0b013e31827de342
复制
发表时间：
2013
影响因子：
3.1
通讯作者：
Golden,MatthewR
中科院分区：
文献类型：
--
作者：
Dombrowski,JuliaC;Golden,MatthewR
与保健的所有方面一样，为有性传播感染风险的人提供临床服务的努力受到资源限制的制约。在世界许多地方，分类性传播感染诊所长期以来在提供性传播感染护理方面发挥着核心作用。然而，在美国，这些诊所面临着不确定的未来。一些政策制定者认为，随着医疗改革确保所有美国人都有医疗保险并获得初级保健，长期以来一直负责照顾主要没有保险的人口的诊所将变得过时。我们认为，即使在美国全面实施《平价医疗法案》之后，性病诊所也应该继续存在。[1]英国、加拿大、荷兰和澳大利亚等国家几十年来一直实行全民医疗保健，它们认为有必要维持全国性的性病诊所网络，我们相信美国在未来几年也将继续需要这些诊所。然而，性传播感染诊所提供服务的传统模式必须改变。1，2这一演变的目标应该是提高效率和护理质量，同时最大限度地提高人口水平的影响，并专注于医疗和公共卫生的需要，其余的卫生保健系统无法解决。提高临床效率的目标是消除不必要的服务需求，降低单位成本，同时保持或提高护理质量和病人满意度的客观措施。在过去的几年里，一个迅速扩大的文献描述了各种测试为重点的“快速”访问模式在性传播感染（STI）诊所。这些模式通常涉及将无症状患者分流到成本较低、时间较短的临床服务3Y7，并经常得到技术创新的帮助，如计算机辅助自我登记、8收集病史的计算机辅助自我面谈（CASI）、7、9 Y11和基于互联网提供检测结果。12这种创新主要是为了提高效率，但也有能力提高护理质量，例如，通过使用电子健康记录数据来促进指定的检测和治疗，并减少使用对个人或公共健康影响最小或没有影响的服务。6通过为患者提供自行采集解剖拭子进行细菌性传播感染筛查的选择，可以进一步提高效率，基本上将这项临床活动从工作人员转移到患者身上，这可能会改善过程中的病例检测。13Y15至少有一个诊所基本上将临床医生从筛查无症状患者的过程中排除出去，方法是使用计算机面谈，向符合条件的患者提供从自动售货机获取样本自我采集包的选择。16
Like all aspects of health care, efforts to provide clinical services for persons at risk for sexually transmitted infections (STI) are constrained by resource limitations. Categorical STI clinics have long played a central role in the provision of STI care in many parts of the world. However, in the United States, these clinics face an uncertain future. Some policy makers believe that the clinics, long tasked with caring for a predominantly uninsured population, will become obsolete as health care reform assures that all Americans have health insurance and access to primary care. We believe that STI clinics should continue to exist even after the Affordable Care Act is fully implemented in the United States. 1 Nations such as the United Kingdom, Canada, the Netherlands, and Australia, all of which have had universal health care for decades, have found it necessary to sustain national networks of STI clinics, and we believe that the United States will also continue to need these clinics in the years to come. However, the traditional model of service delivery provided in STI clinics must evolve. 1, 2 The goal of this evolution should be to improve efficiency and quality of care while maximizing population-level impact and focusing on medical and public health needs that the rest of the health care system cannot address.The objective of improving clinical efficiency is to eliminate demand for unnecessary services and decrease unit costs while simultaneously sustaining or improving objective measures of care quality and patient satisfaction. Over the last several years, a rapidly expanding literature has described a variety of testing-focused ‘‘express’’visit models in sexually transmitted infection (STI) clinics. These models typically involve triaging asymptomatic patients to a lower cost and less time-intensive clinical service3Y7 and have often been aided by technological innovations such as computer-assisted selfregistration, 8 computer-assisted self-interview (CASI) to collect medical history, 7, 9Y11 and internetbased provision of testing results. 12 Such innovations are designed primarily to increase efficiency but also have the capacity to improve the quality of care, for example, by using electronic health record data to promote indicated testing and treatment and to diminish the use of services with minimal or no personal or public health impact. 6 Efficiency may be further enhanced by offering patients the option to self-collect anatomic swabs for bacterial STI screening, essentially task shifting this clinical activity from staff to patients, which may improve case detection in the process. 13Y15 At least one clinic has essentially removed clinicians from the process of screening asymptomatic patients by using a computer interview to offer eligible patients the option to obtain packets for specimen self-collection from a vending machine. 16