Balancing Timely Access and Patient-Physician Continuity in Primary Care

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，通过医生灵活性的透镜-医生为其他医生的病人看病的能力-来解决及时性和连续性问题。初级保健医生天生就具有灵活性;然而，管理和有效利用这种灵活性必须考虑及时性和连续性之间的平衡。这项研究将探讨设计和最佳使用的灵活性，在不同的，但相互关联的能力规划层次结构涉及两个流的不确定的需求，非紧急和紧急，每一个不同的及时性和连续性的要求。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，以及开发可以在实践中轻松实施的药物学。由于初级保健的覆盖面最广，改善获得服务的机会和连续性有可能使整个人口受益。此外，研究结果应适用于其他医疗保健和一般服务环境，及时性和连续性是必不可少的。 与一名受过运筹学培训的初级保健医生以及农村和城市、学术和非学术的各种诊所密切合作，将确保成果的迅速转移。马萨诸塞州西部社区诊所的案例研究将用于在本科生和研究生课程中传播研究成果。

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.