Optimal staffing in community health centers to improve quality of care.
Optimal staffing in community health centers to improve quality of care.
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DOI：
10.1111/1475-6773.13566
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发表时间：
2019-06
影响因子：
3.4
通讯作者：
Q. Luo;A. Dor;P. Pittman
中科院分区：
文献类型：
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作者：
Q. Luo;A. Dor;P. Pittman
目的探讨社区卫生服务中心（CHCs）护理质量生产中的最佳人力配置，考虑职业类别之间的相互作用以及对服务量的贡献。我们将2014年至2016年的统一数据系统与美国国税局非营利组织的纳税申报表数据联系起来。最终数据库包含来自1178个CHCs的3139个中心年观测值。研究设计：我们估计了一个系统的两个广义线性生产函数，护理质量和服务量的输出，使用平均百分比的糖尿病患者与控制A1C水平和高血压患者与控制血压的质量措施。为了探讨人员类别之间的替代性和互补性，我们估计了一个收入函数。初级保健医生和高级实践临床医生实现了类似的质量结果（每全职等效（FTE）慢性病管理分别提高3.2%和3.0%）。高级实践临床医生每FTE产生的收入较少，但雇用成本通常较低。结论随着质量激励进一步融入支付系统，社区卫生服务中心需要优化其劳动力配置，以提高质量。鉴于高级实践临床医生在生产质量方面的相对效率，进一步雇用这些专业人员对社区卫生中心来说是一项具有成本效益的投资。
OBJECTIVE To explore optimal workforce configurations in the production of care quality in community health centers (CHCs), accounting for interactions among occupational categories, as well as contributions to the volume of services. DATA SOURCES We linked the Uniform Data System from 2014 to 2016 with Internal Revenue Service nonprofit tax return data. The final database contained 3139 center-year observations from 1178 CHCs. STUDY DESIGN We estimated a system of two generalized linear production functions, with quality of care and volume of services as outputs, using the average percent of diabetic patients with controlled A1C level and hypertensive patients with controlled blood pressure as quality measures. To explore the substitutability and complementarity between staffing categories, we estimated a revenue function. FINDINGS Primary care physicians and advanced practice clinicians achieve similar quality outcomes (3.2 percent and 3.0 percent improvement in chronic condition management per full-time equivalent (FTE), respectively). Advanced practice clinicians generate less revenue per FTE but are generally less costly to employ. CONCLUSION As quality incentives are further integrated into payment systems, CHCs will need to optimize their workforce configuration to improve quality. Given the relative efficiency of advanced practice clinicians in producing quality, further hiring of these professionals is a cost-effective investment for CHCs.