Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care
Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care
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DOI：
10.3122/jabfm.2015.s1.150087
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发表时间：
2015-09-01
影响因子：
2.9
通讯作者：
Cohen, Deborah J.
中科院分区：
文献类型：
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作者：
Davis, Melinda M.;Balasubramanian, Bijal A.;Cohen, Deborah J.
目的：为了研究行为健康临床医生（BHC）的人员配置，调度，和初级保健实践的方法，提供integratedcare.Methods：观察跨案例比较分析17个初级保健实践在美国集中在实施综合护理之间的相互关系。实践在规模、所有权、地理位置和综合护理经验方面各不相同。一个多学科的团队分析了文件，实践调查，从观察访问，实施日记，和半结构化的采访使用接地theory approach.Results：在17个做法，人员配置比例范围从1 BHC涵盖0.3至36.5初级保健临床医生（PCC）的现场笔记。BHC的日程安排从50分钟的预约到15分钟的开放式灵活日程不等。然而，人员配备和调度模式通常集中在两个方面，并使BHC能够通过转介或热移交进行参与。五种做法主要使用暖式办公室来聘用BHC，BHC与PCC的人员配置比率较高;工作人员中有多个BHC; BHC任命时间较短，更灵活。人员配备和调度结构，使温暖的工作人员支持BHC与患者的参与，同时确定行为健康需求。12个业务部门主要利用转介来聘用初级保健中心，初级保健中心与初级保健中心的人员配置比率较低，初级保健中心的时间表预先安排了访问。这使得一些BHC能够为服务付费，但当患者在临床就诊期间提出行为健康需求时，PCCs也不太容易获得这些服务。这些做法中的三个正在尝试开放的调度和简短的BHC访问，使实时访问，同时管理resources.Conclusion：实践的方法，以PCC-BHC的人员配置，调度，并提供综合护理相互影响，并形成了当地的情况。实践领导者、教育工作者、临床医生、资助者、研究人员和政策制定者在寻求优化综合护理系统时必须考虑这些因素。
Purpose: To examine the interrelationship among behavioral health clinician (BHC) staffing, scheduling, and a primary care practice's approach to delivering integrated care.Methods: Observational cross-case comparative analysis of 17 primary care practices in the United States focused on implementation of integrated care. Practices varied in size, ownership, geographic location, and integrated care experience. A multidisciplinary team analyzed documents, practice surveys, field notes from observation visits, implementation diaries, and semistructured interviews using a grounded theory approach.Results: Across the 17 practices, staffing ratios ranged from 1 BHC covering 0.3 to 36.5 primary care clinicians (PCCs). BHC scheduling varied from 50-minute prescheduled appointments to open, flexible schedules slotted in 15-minute increments. However, staffing and scheduling patterns generally clustered in 2 ways and enabled BHCs to be engaged by referral or warm handoff. Five practices predominantly used warm handoffs to engage BHCs and had higher BHC-to-PCC staffing ratios; multiple BHCs on staff; and shorter, more flexible BHC appointment schedules. Staffing and scheduling structures that enabled warm handoffs supported BHC engagement with patients concurrent with the identification of behavioral health needs. Twelve practices primarily used referrals to engage BHCs and had lower BHC-to-PCC staffing ratios and BHC schedules prefilled with visits. This enabled some BHCs to bill for services, but also made them less accessible to PCCs in when patients presented with behavioral health needs during a clinical encounter. Three of these practices were experimenting with open scheduling and briefer BHC visits to enable real-time access while managing resources.Conclusion: Practices' approaches to PCC-BHC staffing, scheduling, and delivery of integrated care mutually influenced each other and were shaped by the local context. Practice leaders, educators, clinicians, funders, researchers, and policy makers must consider these factors as they seek to optimize integrated systems of care.