Balancing Timely Access and Patient-Physician Continuity in Primary Care

在初级保健中平衡及时就诊和患者与医生的连续性

• 批准号: 1031550
• 负责人: Hari Jagannatha Balasubramanian
• 金额: $ 27.2万
• 依托单位: University of Massachusetts Amherst
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-15 至 2013-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1031550&HistoricalAwards=false
• 关键词: Balancing; Timely; Access; Patient; Physician

With the nationwide shortage of primary care physicians (PCPs), practices are finding it increasingly difficult to deliver two vital and conflicting patient-centered metrics: 1) Timeliness i.e. ensuring patients get access to care as quickly as possible; 2) Patient-physician continuity, i.e. ensuring patients see their own PCP as much as possible. This proposal will develop new stochastic optimization approaches for addressing timeliness and continuity through the lens of physician flexibility - the ability of a physician to see patients of other physicians. Physicians in primary care are inherently flexible; however, the management and efficient use of this flexibility has to consider the balance between timeliness and continuity. The research will explore the design and optimal use of flexibility at different but interlinked levels of the capacity planning hierarchy involving two streams of uncertain demand, non-urgent and urgent, each with different timeliness and continuity requirements. If successful, the results will be used to develop optimal policies and insights on capacity allocation and dynamic patient scheduling under different flexibility configurations, as well as to develop heuristics that can be easily implemented in practice. Since primary care has the broadest possible reach, improved access and continuity has the potential to benefit the population as a whole. Furthermore, the findings should be applicable to other healthcare and general service settings where timeliness and continuity are essential. Close collaboration with a primary care physician trained in operations research and a wide range of clinics, rural and urban, academic and non-academic, will ensure the quick transfer of results. The case study of a community clinic in Western Massachusetts will be used to disseminate research findings in undergraduate and graduate courses.

随着全国范围内初级保健医生（pcp）的短缺，实践发现越来越难以提供两个至关重要且相互冲突的以患者为中心的指标：1)及时性，即确保患者尽快获得护理；2)患者-医生连续性，即确保患者尽可能多地看到自己的PCP。该提案将开发新的随机优化方法，通过医生灵活性（一名医生为其他医生看病的能力）来解决及时性和连续性问题。初级保健医生天生具有灵活性；但是，管理和有效利用这种灵活性必须考虑到及时性和连续性之间的平衡。本研究将探讨在容量规划层次的不同但相互关联的层面上灵活性的设计和最佳使用，涉及两种不确定需求流，非紧急和紧急，每一种都具有不同的及时性和连续性要求。如果成功，研究结果将用于制定不同灵活性配置下的容量分配和动态患者调度的最佳策略和见解，以及开发易于在实践中实施的启发式方法。由于初级保健具有尽可能广泛的覆盖范围，因此改善获得和连续性有可能使全体人民受益。此外，调查结果应适用于其他医疗保健和一般服务环境，这些环境对及时性和连续性至关重要。与受过运学培训的初级保健医生以及农村和城市、学术和非学术的广泛诊所密切合作，将确保成果的快速转移。在马萨诸塞州西部的一个社区诊所的案例研究将用于传播研究成果，在本科和研究生课程。