Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study.
Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study.
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DOI：
10.1080/16549716.2018.1451455
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发表时间：
2018
影响因子：
2.6
通讯作者：
Huchko MJ
中科院分区：
文献类型：
--
作者：
Olwanda E;Shen J;Kahn JG;Bryant-Comstock K;Huchko MJ
背景：改善病人流动和减少过度拥挤可以提高质量、护理的及时性和病人的满意度。鉴于低资源国家的预防保健利用率较低，改善病人流动在这些环境中尤为重要。目的：通过自收集的人乳头瘤病毒(HPV)比较两种宫颈癌筛查策略的病人流量和提供者效率。方法：我们收集了肯尼亚米戈里县农村地区12个社区的宫颈癌筛查患者的时间和运动数据，作为更大规模的整群随机试验的一部分。6个社区随机参加社区卫生运动(CHC)筛查，6个社区在政府诊所进行筛查。我们量化了患者流量：筛查每个活跃阶段的持续时间和等待时间，以及一天中每小时到达CHC和诊所的患者数量。此外，对于四家CHC，我们收集了提供者的时间和运动数据，并以活动(服务交付)时间与在诊所花费的总时间的比率来衡量提供者的效率。结果：筛查就诊总时长分别为42分钟和87分钟(P<0.001)。儿童健康中心的总活动时间持续时间更长，平均每位患者为28分钟，而诊所为15分钟，这主要是由于集体教育持续时间的差异(P<；0.001)。诊所的挂号等待时间为36分钟，这解释了设置之间的大部分差异，但有时也会纳入其他医疗服务。结论：与CHC相比，诊所的病人流量有很大的不同。在CHC的较短持续时间表明，该模型在限制筛查时间方面对患者有利。未来为扩大规模而设计的宫颈癌筛查计划应该考虑这一优势如何提高满意度和接受度。对于以诊所为基础的筛查计划，可以努力减少登记等待时间。
Background: Improving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings. Objective: Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV). Methods: We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic. Results: Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services. Conclusions: There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.
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影响因子：
3.8
作者：
Huchko MJ;Kahn JG;Smith JS;Hiatt RA;Cohen CR;Bukusi E
通讯作者：
Bukusi E
影响因子：
3.6
作者：
Best, Allyson M.;Dixon, Cinnamon A.;Ward, Michael J.
通讯作者：
Ward, Michael J.
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影响因子：
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作者：
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通讯作者：
Obermeyer, Ziad
影响因子：
8.8
作者：
Harnett, Miriam J. P.;Correll, Darin J.;Hepner, David L.
通讯作者：
Hepner, David L.
影响因子：
2.4
作者：
Preyde, Michele;Crawford, Kim;Mullins, Laura
通讯作者：
Mullins, Laura