Impact of New Physician Residents on Veterans' Access to Care

新住院医生对退伍军人获得护理的影响

• 批准号: 10176586
• 负责人: T. MICHAEL KASHNER
• 金额: --
• 依托单位: VA LOMA LINDA HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176586
• 关键词: Accountability; Address; Caring; Characteristics; Clinical; Congresses; Data; Education; Educational process of instructing; Employee; Employment; Ensure; Environment; Face; Faculty; Funding; Future; Health Professional; Health Services; Health Services Accessibility; Healthcare; Improve Access; Laws; Leadership; Learning; Left; Measures; Medical; Medical Staff; Medical center; Mental Health; Methods; Mind; Modeling; Outcome; Patient Care; Perception; Performance; Physicians; Positioning Attribute; Primary Health Care; Production; Psychiatry; Quality of Care; Reporting; Research Personnel; Resource Allocation; Services; Supervision; Surveys; Testing; Time; Training; Training Programs; Training and Education; Uncertainty; Veterans; Wait Time; Work; Workload; base; care providers; clinical care; cost; design; educational atmosphere; experience; graduate medical education; health administration; improved; interest; medical specialties; multilevel analysis; predictive modeling; programs; recruit; response; satisfaction; simulation; willingness

 DESCRIPTION (provided by applicant): To complete requirements under the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act), VHA through its Office of Academic Affiliations must place 1,500 new Graduate Medical Education (GME) resident slots, or approximately 4,500 new residents, into VA medical centers within the next five years, focusing on primary care, mental health, and other underserved specialties. VA must also report on their progress, describe why if any they are unable to fill these new positions, and report if new residents are willing to consider VA for futue employment. GME is important to VA since presently one-third of all U.S. physician residents rotate through a VA medical center and are involved in 37% of VA's physician services while caring annually for 2.5 million veterans. Presently, VA clinical training programs are VA's best means to recruit medical staff, as nearly 60% of VA staff physicians rotated through a VA medical center as part of their GME training. In FY 2005-2010, OAA increased the number of residents by 1,200 positions involving 3,600 residents as part of a GME Enhancement Program 2005-2010. However, there is grave concern that VA may not have sufficient medical staff or space to accommodate these new "Choice" residents. Our purpose is to determine if, and how, VA/OAA can accommodate 4,500 new Choice Act residents across medical centers and how Choice residents will contribute to GME education outcomes in the face of potentially rising resident to staff ratios. GME education outcomes include clinical opportunities provided to residents to gain meaningful patient care experience, satisfaction over the clinical learning experience, and likelihood residents will consider their clinical host for future employment. Our objective is to determine at present staffing and resident levels do trainees add to clinical workload net of supervision costs. We also assess whether the "exogenous" GME Enhancement Program 2005-2010 resulted in expanding VA clinical opportunities, rising satisfaction rates with VA's clinical learning environment, and ultimately on increasing residents' employability, or their willingness to consider VA for future employment. By studying GME Enhancement of FY 2005-2010, OAA can forecast potential GME education outcomes for the new Choice Act for FY 2015-2019. Data are obtained from CDW through VA's Allocation Resource Center, OAA's paid slot file, survey of Designated Learning Officers, and Learners' Perceptions Survey of VA trainees, plus VHA's All Employee Survey data for FY 2001 through FY 2015. Cross-nested, multilevel models will be selected using a Best Approximating Model Method to measure the impact of exogenous increases in GME Enhancement 2005-2010 residents on clinical workload, and on GME education outcomes (clinical opportunities, satisfaction, employability), by specialty (primary care, psychiatry, and other specialties), and a a function of characteristics of the medical center, residents, and clinical staff, among others. The performance of the final workload and outcome models will be assessed, and applied to simulation studies to determine how different allocations of Choice positions across VA medical centers will impact national GME education outcomes planned for FY2016-2020. Finally, timing of the study, with on-going relationships with OAA, will enable investigators a unique opportunity to test some of its predictions and assess overall performance of estimated predictive models, with corrective actions, if necessary, planned.

 描述(由申请人提供)： 为了满足2014年退伍军人准入、选择和责任法案(Choice Act)的要求，VHA必须通过其学术关联办公室在未来五年内将1500个新的研究生医学教育(GME)住院医生名额或约4500名新住院医生安置到退伍军人医疗中心，重点放在初级保健、心理健康和其他服务不足的专业上。退伍军人管理局还必须报告他们的进展情况，说明为什么他们无法填补这些新职位，并报告新居民是否愿意考虑退伍军人管理局未来的工作。GME对退伍军人管理局很重要，因为目前三分之一的美国住院医师通过退伍军人医疗中心轮换，参与退伍军人管理局37%的医生服务，每年照顾250万退伍军人。目前，退伍军人管理局临床培训计划是退伍军人管理局招聘医务人员的最佳手段，因为近60%的退伍军人管理局员工医生在退伍军人管理局医疗中心轮换，作为其GME培训的一部分。在2005-2010财年，作为GME强化计划的一部分，OAA增加了1,200个职位，涉及3,600名居民。然而，令人深切关注的是退伍军人事务部可能没有足够的医疗人员或空间来容纳这些新的“选择”居民。我们的目的是确定退伍军人管理局/OAA能否以及如何在医疗中心容纳4,500名新的Choice Act居民，以及面对潜在的居民与员工比例上升的情况，Choice居民将如何为GME教育成果做出贡献。GME教育成果包括为住院医生提供获得有意义的患者护理体验的临床机会、对临床学习体验的满意度，以及住院医生考虑未来就业的可能性。我们的目标是确定在目前的人员编制和住院医生水平上，受训人员在扣除监督费用后是否增加了临床工作量。我们还评估了2005-2010年的“外源性”GME增强计划是否扩大了VA的临床机会，提高了对VA临床学习环境的满意率，并最终增加了住院医生的 就业能力，或他们愿意考虑退伍军人管理局未来的就业。通过研究2005-2010财年GME的改进，OAA可以预测2015-2019财年新选择法案潜在的GME教育成果。数据通过退伍军人管理局的分配资源中心、OAA的付费时段文件、指定学习官员调查和退伍军人管理局学员的学习者感知调查以及VHA 2001财年至2015财年的所有员工调查数据从CDW获得。将使用最佳近似模型方法选择交叉嵌套的多水平模型，以衡量2005-2010年度GME增强住院医生的外源性增加对临床工作量、GME教育结果(临床机会、满意度、就业能力)、按专业(初级保健、精神病学和其他专业)以及医疗中心、住院医生和临床工作人员等特征的功能的影响。将评估最终工作量和结果模型的表现，并将其应用于模拟研究，以确定退伍军人医疗中心选择职位的不同分配将如何影响2016-2020财年计划的全国GME教育成果。最后，这项研究的时间安排以及与高龄津贴的持续关系，将使调查人员有一个独特的机会来测试其一些预测，并评估估计预测模型的整体表现，并在必要时计划采取纠正行动。