Patient experiences after implementing lean primary care redesigns.
Patient experiences after implementing lean primary care redesigns.
复制标题
实施精益初级保健重新设计后的患者体验。
DOI：
10.1111/1475-6773.13605
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发表时间：
2021
影响因子：
3.4
通讯作者：
Liang,Su-Ying
中科院分区：
文献类型：
--
作者：
Hung,DorothyY;Mujal,Gabriela;Jin,Anqi;Liang,Su-Ying
目的探讨精益初级保健重新设计对患者护理满意度和护理及时性的影响。数据/设置我们在一个大型门诊护理系统中使用患者调查和带时间戳的电子健康记录（EHR）数据。基于DesignLean的临床空间和护理团队工作流程的变化在一个试验点实施，然后扩展到整个系统的所有初级保健部门。重新设计包括标准化检查室的设备和患者教育材料，简化呼叫管理功能，将医生和医疗助理共同安置在一个共享的工作空间中，并创建新的护理团队工作流程。我们采用非随机的阶梯形研究设计和分段回归与中断时间序列分析来检验精益对患者预后的影响。数据收集我们分析了EHR记录的患者满意度评分和等待时间。这些纵向数据收集自2011年1月至2016年12月，来自46个初级保健部门的317个医生领导的团队。主要研究结果：实施精益再设计后，患者报告在办公室就诊期间与护理人员相处时间的满意度提高了44.8% （P< 0.05）。他们还报告说，他们对护理人员倾听他们所关心的问题的能力的满意度提高了71.6%，并且在访问中感受到工作人员的帮助增加了55.4% （P< 0.01）。根据每月的电子病历数据，从患者要求常规预约到安排的就诊日之间的时间从基线平均每月减少2% （P< 0.01）。在就诊当天，患者等待就诊的时间也逐渐减少，平均每月减少1.2% （P< 0.05）。结论：在初级保健机构中，实施精益后患者的护理体验尚未得到广泛研究。我们发现精益再设计产生了改进，可以加强临床操作，同时提高对患者的价值。
ObjectiveTo examine the effect of Lean primary care redesigns on patient satisfaction with care and timeliness of care received.Data/SettingWe used patient surveys and time‐stamped electronic health record (EHR) data in a large ambulatory care system.DesignLean‐based changes to clinical spaces and care team workflows were implemented in one pilot site and then scaled to all primary care departments across the system. Redesigns included standardizing equipment and patient education materials in examination rooms, streamlining call management functions, co‐locating physician and medical assistant dyads in a shared workspace, and creating new care team workflows. We used a non‐randomized stepped‐wedge study design and segmented regression with interrupted time series analysis to examine Lean impacts on patient outcomes.Data CollectionWe analyzed patient satisfaction ratings and wait times as documented by the EHR. These longitudinal data were collected for 317 physician‐led teams in 46 primary care departments from January 2011 to December 2016.Principal FindingsAfter implementation of Lean redesigns, patients reported a 44.8 percent increase in satisfaction with the adequacy of time spent with care providers during office visits (P< .05). They also reported 71.6 percent higher satisfaction with their care provider's ability to listen to their concerns, and a 55.4 percent increase in perceived staff helpfulness at the visit (P< .01). Based on monthly EHR data, the amount of time elapsed between a patient request for a routine appointment and the scheduled visit day decreased from baseline by an average 2 percent per month (P< .01). On the day of the visit, patient wait times to be seen also decreased gradually by an average 1.2 percent per month (P< .05).ConclusionsPatient experiences of care after Lean implementations have not been widely studied in primary care settings. We found that Lean redesign yielded improvements that may strengthen clinical operations while enhancing value for patients.