Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians.
Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians.
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DOI：
10.1007/s11606-021-07178-6
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发表时间：
2022-08
影响因子：
5.7
通讯作者：
Liang, Su-Ying
中科院分区：
文献类型：
--
作者：
Hung, Dorothy Y.;Mujal, Gabriela;Jin, Anqi;Liang, Su-Ying
关键词：
评估精益初级保健重新设计对医生每天工作时间的影响。这项观察性研究基于大型门诊护理服务系统中 317 名初级保健医生捕获的 9200 万条带有时间戳的 Epic® EHR 访问日志。研究纳入了 17 个诊所设施，拥有 46 个初级保健科室。我们进行了间断时间序列分析，以监测 6 年来医生工作模式的变化。主要衡量指标包括每日总工作时间；考场外花在“桌面医学”上的时间；就诊期间与患者相处的时间；诊所结束后的时间仍然有效，即每天看完最后一位病人后；和远程工作时间。在精益实施的第一年，医生全天（包括门诊时间）花在桌面 EHR 活动上的时间分别减少了 10.9%（95% CI：-22.2，-2.03）和 8.3%（95% CI：-13.8，-2.12）。到精益实施的第三年，医生的每日总工作时间（包括桌面活动和办公室就诊时间）减少了 20%（95% CI：-29.2，-9.60）。这些发现表明，精益重新设计可能与初级保健医生节省时间有关。然而，由于这是一项观察性分析，因此有必要进行进一步的研究（例如随机试验），以确定精益干预对医生工作经验的影响。
To assess the impact of Lean primary care redesigns on the amount of time that physicians spent working each day. This observational study was based on 92 million time-stamped Epic® EHR access logs captured among 317 primary care physicians in a large ambulatory care delivery system. Seventeen clinic facilities housing 46 primary care departments were included for study. We conducted interrupted time series analysis to monitor changes in physician work patterns over 6 years. Key measures included total daily work time; time spent on “desktop medicine” outside the exam room; time spent with patients during office visits; time still working after clinic, i.e., after seeing the last patient each day; and remote work time. The amount of time that physicians spent on desktop EHR activities throughout the day, including after clinic hours, decreased by 10.9% (95% CI: −22.2, −2.03) and 8.3% (95% CI: −13.8, −2.12), respectively, during the first year of Lean implementation. Total daily work hours among physicians, which included both desktop activity and time in office visits, decreased by 20% (95% CI: −29.2, −9.60) by the third year of Lean implementation. These findings suggest that Lean redesign may be associated with time savings for primary care physicians. However, since this was an observational analysis, further study is warranted (e.g., randomized trial) —to determine the impact of Lean interventions on physician work experiences.
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影响因子：
5.7
作者：
Chen, Melinda A.;Hollenberg, James P.;Casalino, Lawrence P.
通讯作者：
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影响因子：
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DOI：
10.1046/j.1365-2710.2002.00430.x
发表时间：
2002-08-01
影响因子：
2
作者：
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通讯作者：
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影响因子：
7.2
作者：
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通讯作者：
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