Advanced access - Reducing waiting and delays in primary care
Advanced access - Reducing waiting and delays in primary care
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DOI：
10.1001/jama.289.8.1035
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发表时间：
2003-02-26
影响因子：
120.7
通讯作者：
Berwick, DM
中科院分区：
文献类型：
--
作者：
Murray, M;Berwick, DM
延误护理是当前卫生保健系统的一个持久且令人不快的特征。尽管延误似乎是不可避免的，并与资源限制有关，但往往两者都不是。相反，它通常是计划外的、不合理的调度和资源分配的结果。应用排队论和工业工程原理，适当地适应临床环境，可以大幅减少延误，即使是在小的实践中，也不需要额外的资源。一种模式，有时被称为高级接入，越来越多地被证明可以减少初级保健的等待时间。高级接入的核心原则是，打电话预约医生就诊的患者可以在同一天获得预约。如果患者对预约的需求永久性地大于医生提供预约的能力，那么高级访问是不可持续的。高级准入的六个要素在其应用中很重要：平衡供需、减少积压、减少预约类型的多样性、为特殊情况制定应急计划、努力调整需求情况以及增加瓶颈资源的可用性。尽管这些原则很强大，但它们与卫生保健组织中根深蒂固的信念和既定做法背道而驰。采用这些原则需要强有力的领导、投资和支持。
Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither.. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application: balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support.