Striving toward team-based continuity: provision of same-day access and continuity in academic primary care clinics
Striving toward team-based continuity: provision of same-day access and continuity in academic primary care clinics
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DOI：
10.1186/s12913-019-3943-2
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发表时间：
2019-03-04
影响因子：
2.8
通讯作者：
Krein, Sarah L.
中科院分区：
文献类型：
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作者：
Forman, Jane H.;Robinson, Claire H.;Krein, Sarah L.
背景以病人为中心的医疗之家的一个重要目标是在保持连续性的同时，增加对紧急需求的及时访问。在学术初级保健诊所，满足这一目标，沿着与培训医疗居民和相关的专业人士，是challenging.MethodsThe本研究的目的是了解学术初级保健诊所如何提供连续性要求同一天访问的患者，并确定可能影响网站一级的成功因素。我们进行了定性访谈，从2013年12月至2014年10月，在19个退伍军人健康管理局学术附属医疗中心参与住院医师项目的初级保健领导。采访录音是逐字转录的。为了分析数据，我们为每个网站创建了全面的，结构化的成绩单摘要。然后将研究中心总结输入NVivo 10软件，并按主要类别进行编码，以便于病例内和病例间分析。使用矩阵analysis.ResultsInterviewees发现，它具有挑战性，提供连续性的同一天的人访问的网站的主题和模式。大多数站点采取基于团队的方法来确保连续性并提供当天访问的覆盖，特别是在其覆盖算法中使用NP、PA和RN。此外，他们报告了几种适应措施，增加了无预约患者的多种连续性，亲自就诊之间的紧急护理和随访护理。虽然这项研究的重点是纵向连续性，无论是由个人的PCP或专业团队，信息的连续性和监督的连续性，以及在较小程度上，关系和管理的连续性，也在我们的采访中得到了解决。最后，大多数受访者报告诊所打算提供以病人为中心，以团队为基础的护理和一个强大的教育经验的学员，并endeavor结构的方式，使这两个missions.ConclusionsIn争夺提供连续性和教育新的临床医生之间的紧张关系，诊所已重新概念化的连续性，以团队为基础，创造替代战略，以同一天的访问与一个通常的供应商，再加上沟通策略。了解这些策略对不同类型的连续性以及患者体验和结果的影响是进一步开发和传播有效模型的关键步骤，以提高连续性并在学术诊所环境中过渡到基于团队的护理。
BackgroundAn important goal of the patient-centered medical home is increasing timely access for urgent needs, while maintaining continuity. In academic primary care clinics, meeting this goal, along with training medical residents and associated professionals, is challenging.MethodsThe aim of this study was to understand how academic primary care clinics provide continuity to patients requesting same-day access and identify factors that may affect site-level success. We conducted qualitative interviews from December 2013-October 2014 with primary care leadership involved with residency programs at 19 Veterans Health Administration academically-affiliated medical centers. Interview recordings were transcribed verbatim. To analyze the data, we created comprehensive, structured transcript summaries for each site. Site summaries were then entered into NVivo 10 software and coded by main categories to facilitate within-case and cross-case analyses. Themes and patterns across sites were identified using matrix analysis.ResultsInterviewees found it challenging to provide continuity for same-day in-person visits. Most sites took a team-based approach to ensure continuity and provide coverage for same-day access, notably using NPs, PAs, and RNs in their coverage algorithms. Further, they reported several adaptations that increased multiple types of continuity for walk-in patients, urgent care between in-person visits, and follow-up care. While this study focused on longitudinal continuity, both by individual PCPs or by a team of professionals, informational continuity and continuity of supervision, as well as, to a lesser extent, relational and management continuity, were also addressed in our interviews. Finally, most interviewees reported clinic intention to provide patient-centered, team-based care and a robust educational experience for trainees, and endeavored to structure their clinics in ways that align these two missions.ConclusionsIn contending with the tension between providing continuity and educating new clinicians, clinics have re-conceptualized continuity as team-based, creating alternative strategies to same-day visits with a usual provider, coupled with communication strategies. Understanding the effect of these strategies on different types of continuity as well as patient experience and outcomes are key next steps in the further development and dissemination of effective models for improving continuity and the transition to team-based care in the academic clinic setting.