Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers
Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers
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DOI：
10.1001/jamanetworkopen.2018.7096
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发表时间：
2019-01-01
影响因子：
13.8
通讯作者：
Shulkin, David
中科院分区：
文献类型：
--
作者：
Penn, Madeline;Bhatnagar, Saurabha;Shulkin, David
重要性在美国退伍军人事务部（VA）卫生保健系统中，对患者的卫生保健获取的充分性提出了关注。为了确定在VA医疗中心接受护理的新患者的等待时间，并将VA医疗中心的等待时间与私营部门（PS）的等待时间进行比较。对2014年和2017年15个主要大都市地区的VA医疗中心的初级保健，皮肤科，心脏科或骨科的新预约等待时间进行了重复的横断面研究。PS的比较数据来自一项公开的调查，该调查使用了秘密购物者调查方法。次要分析评价了2014年至2017年期间整个VA系统中观察到的总体和独特患者的变化以及患者满意度调查的护理访问措施。主要结局和指标关注的结局是患者等待时间。VA中的等待时间直接根据患者计划确定。结果与PS相比，2014年新预约的总体平均VA等待时间相似（平均[SD]等待时间，PS为18.7 [7.9]天，VA为22.5 [7.3]天; P = 0.20）。2014年，退伍军人事务部的等待时间与各专业和地区的PS相似。2017年，VA新预约的总体等待时间短于PS（平均值[SD]，17.7 [5.9] vs 29.8 [16.6]天; P
IMPORTANCE Concerns have been raised about the adequacy of health care access among patients cared for within the United States Department of Veterans Affairs (VA) health care system.OBJECTIVES To determine wait times for new patients receiving care at VA medical centers and compare wait times in the VA medical centers with wait times in the private sector (PS).DESIGN, SETTING, AND PARTICIPANTS A retrospective, repeated cross-sectional study was conducted of new appointment wait times for primary care, dermatology, cardiology, or orthopedics at VA medical centers in 15 major metropolitan areas in 2014 and 2017. Comparison data from the PS came from a published survey that used a secret shopper survey approach. Secondary analyses evaluated the change in overall and unique patients seen in the entire VA system and patient satisfaction survey measures of care access between 2014 and 2017.MAIN OUTCOMES AND MEASURES The outcome of interest was patient wait time. Wait times in the VA were determined directly from patient scheduling. Wait times in the PS were as reported in Merritt Hawkins surveys using the secret shopper method.RESULTS Compared with the PS, overall mean VA wait times for new appointments in 2014 were similar (mean [SD] wait time, 18.7 [7.9] days PS vs 22.5 [7.3] days VA; P =.20). Department of Veterans Affairs wait times in 2014 were similar to those in the PS across specialties and regions. In 2017, overall wait times for new appointments in the VA were shorter than in the PS (mean [SD], 17.7 [5.9] vs 29.8 [16.6] days; P