Competing Demands: Scheduling Challenges in Being Veteran-centric in the Setting of Health System Initiatives to Improve Access
Competing Demands: Scheduling Challenges in Being Veteran-centric in the Setting of Health System Initiatives to Improve Access
复制标题
相互竞争的需求： 在医疗系统改善就医环境的举措中，以退伍军人为中心所面临的时间安排挑战
DOI：
10.1093/milmed/usaa520
复制
发表时间：
2021-11-01
影响因子：
1.2
通讯作者：
Young, Jessica
中科院分区：
文献类型：
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作者：
Moldestad, Megan;Stryczek, Krysttel C.;Young, Jessica
简介：退伍军人健康管理局（VHA）在2016年继续加强退伍军人医疗保健服务的历史，推出了ChooseVA（Nee：MyVA Access）。该计划旨在改造VHA，并迅速增加退伍军人在所有VHA设施中获得护理的机会。与本文相关的包括改善以患者为中心的调度的任务。在优先考虑以患者为中心的调度时，VHA和其他大型医疗保健系统具有矛盾的任务，即提供不仅满足个体患者需求而且满足所服务人群的集体需求的医疗保健。据我们所知，满足这些相互竞争的需求还没有探索通过供应商和工作人员实施以患者为中心的调度practices.Materials和方法的观点和经验：这是一个定性的探索性研究，并批准为质量改进（因此免于机构审查委员会审查）。我们访问了25个VHA设施。根据农村、区域和设施访问性能评级选择网站。数据收集包括半结构化访谈和焦点小组。主要知情者参与者包括当地的领导，管理人员，提供者和支持人员在初级保健，专科护理和精神卫生服务线。我们分析了转录的录音使用归纳内容分析，以确定障碍，促进者，和上下文因素影响的实施以病人为中心的scheduling.Results：我们进行了208个个人访谈和焦点小组之间的2017年7月至11月。与会者表示致力于以患者为中心的方法，以改善退伍军人的护理，说明努力和挑战，以满足退伍军人的需求和偏好。以退伍军人为中心意味着适应退伍军人，在满足一个退伍军人与所有退伍军人的需求、管理对当天访问的期望以及对性能指标的潜在影响之间存在紧张关系。战略的重点是通过教育和建立新的期望，同时认识到不同的需求之间的亚组接受VHA care.Conclusions：退伍军人健康管理局的工作人员采用了任务驱动，文化敏感的方法，以满足退伍军人人口的多样化调度需求。虽然VHA可能是唯一的，但它可以为其他医疗保健系统中的其他文化特定人群提供以患者为中心的调度实践。继续努力把退伍军人在VHA医疗保健服务的中心，通过有意义的方式让他们参与，同时尊重他们的独特需求是必不可少的。关于退伍军人对访问的看法的数据即将公布，我们希望这将进一步有助于在VHA内展开对访问的理解。
Introduction:The Veterans Health Administration's (VHA) history of enhancing Veterans' healthcare access continued in 2016 with the launch of ChooseVA (nee: MyVA Access). This initiative was designed to transform the VHA and rapidly increase Veteran's access to care across all the VHA facilities. Relevant to this article include mandates to improve patient-centered scheduling. In prioritizing patient-centered scheduling, the VHA and other large healthcare systems have the paradoxical task of providing health care that meets not only the needs of individual patients but also the collective needs of the population served. To our knowledge, meeting these competing needs has not been explored through the perspectives and experiences of providers and staff implementing patient-centered scheduling practices.Materials and Methods:This was a qualitative exploratory study and was sanctioned as quality improvement (and thus exempt from Institutional Review Board review). We conducted visits at 25 VHA facilities. Sites were selected based on rurality, region, and facility access performance ratings. Data collection included semi-structured interviews and focus groups. Key informant participants included local leadership, administrators, providers, and support staff across primary care, specialty care, and mental health service lines. We analyzed transcribed audio recordings using inductive content analysis to identify barriers, facilitators, and contextual factors affecting the implementation of patient-centered scheduling.Results:We conducted 208 individual interviews and focus groups between July and November 2017. Participants expressed dedication to patient-centered approaches to improve access to care for Veterans, stating efforts and challenges to meeting Veterans' needs and preferences. Being Veteran-centric meant accommodating Veterans, with a tension between meeting the needs of one Veteran versus all Veterans, managing expectations of same-day access, and potential hits to performance metrics. Strategies focused on engaging Veterans through education and establishing new expectations while recognizing the differing needs among subgroups receiving VHA care.Conclusions:Veterans Health Administration staff employed a mission-driven, culturally sensitive approach to meeting the diverse scheduling needs of the Veteran population. While potentially unique to the VHA, it may inform patient-centered scheduling practices for other culturally specific populations in other healthcare systems. Continued efforts to put Veterans at the center of VHA healthcare delivery by engaging them in meaningful ways while honoring their distinct needs are essential. Data are forthcoming on Veterans' perspectives of access, which we hope will further contribute to unfolding understandings of access within the VHA.