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: 9084344
• 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/9084344
• 关键词: Accountability; Accountability; Address; Address; Caring; Caring; Characteristics; Characteristics; Clinical; Clinical; Congresses; Congresses; Data; Data; Education; Education; Educational process of instructing; Educational process of instructing; Employee; Employee; Employment; Employment; Ensure; Ensure; Environment; Environment; Face; Face; Faculty; Faculty; Funding; Funding; Future; Future; Health Professional; Health Professional; Health Services; Health Services; Health Services Accessibility; Health Services Accessibility; Healthcare; Healthcare; Improve Access; Improve Access; Laws; Laws; Lead; Leadership; Leadership; Learning; Learning; Left; Left; Licensing; Measures; Measures; Medical; Medical; Medical Staff; Medical Staff; Medical center; Medical center; Mental Health; Mental Health; Methods; Methods; Mind; Mind; Modeling; Modeling; Outcome; Outcome; Patient Care; Patient Care; Perception; Perception; Performance; Performance; Physicians; Physicians; Positioning Attribute; Positioning Attribute; Primary Health Care; Primary Health Care; Production; Production; Provider; Psychiatry; Psychiatry; Quality of Care; Quality of Care; Recruitment Activity; Reporting; Reporting; Research Personnel; Research Personnel; Resource Allocation; Resource Allocation; Services; Services; Supervision; Supervision; Surveys; Surveys; Testing; Testing; Time; Time; Training; Training; Training Programs; Training Programs; Training and Education; Uncertainty; Uncertainty; Veterans; Veterans; Wait Time; Work; Work; Workload; Workload; base; base; care providers; clinical care; clinical care; cost; cost; design; design; educational atmosphere; educational atmosphere; experience; experience; graduate medical education; graduate medical education; health administration; health administration; improved; improved; interest; interest; medical specialties; medical specialties; multilevel analysis; multilevel analysis; predictive modeling; predictive modeling; programs; programs; recruit; response; response; satisfaction; satisfaction; simulation; simulation; willingness; 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）： 为了完成2014年退伍军人准入，选择和责任法案（选择法案）的要求，VHA通过其学术附属机构办公室必须在未来五年内将1，500个新的研究生医学教育（GME）居民名额或大约4，500名新居民纳入VA医疗中心，重点关注初级保健，心理健康和其他服务不足的专业。VA还必须报告他们的进展情况，描述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VA未来的就业。GME对VA很重要，因为目前美国三分之一的医生居民通过VA医疗中心轮换，参与VA 37%的医生服务，同时每年照顾250万退伍军人。目前，VA临床培训计划是VA招募医务人员的最佳手段，因为近60%的VA工作人员医生通过VA医疗中心轮换，作为他们GME培训的一部分。在2005-2010财政年度，作为2005-2010年全球医疗保健增强方案的一部分，OAA增加了1 200个住院医师职位，涉及3 600名住院医师。然而，令人严重关注的是，退伍军人事务部可能没有足够的医务人员或空间来容纳这些新的“选择”居民。我们的目的是确定VA/OAA是否以及如何能够在医疗中心容纳4，500名新的选择法案居民，以及面对潜在的居民与员工比例上升，选择居民将如何为GME教育成果做出贡献。GME教育成果包括为居民提供的临床机会，以获得有意义的患者护理经验，对临床学习经验的满意度，以及居民考虑未来就业的临床宿主的可能性。我们的目的，是要确定在扣除督导费用后，现时的人手和驻院医生人数是否会增加见习医生的临床工作量。我们还评估了2005-2010年的“外源性”GME增强计划是否扩大了VA临床机会，提高了VA临床学习环境的满意度，并最终增加了居民的 就业能力，或他们愿意考虑VA为未来的就业。通过研究2005-2010财年的GME增强，OAA可以预测2015-2019财年新选择法案的潜在GME教育成果。数据来自CDW通过VA的分配资源中心，OAA的付费插槽文件，指定学习官员的调查，VA学员的学习者感知调查，以及VHA的2001财年至2015财年的所有员工调查数据。将使用最佳近似模型方法选择交叉嵌套的多水平模型，以测量2005-2010年GME增强居民的外源性增加对临床工作量和GME教育结果的影响（临床机会、满意度、就业能力），按专业分列（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的特征的函数。将评估最终工作量和结果模型的性能，并将其应用于模拟研究，以确定VA医疗中心选择职位的不同分配将如何影响2016 -2020财年计划的国家GME教育成果。最后，研究的时间安排，以及与OAA的持续关系，将使研究人员有一个独特的机会来测试其一些预测，并评估估计的预测模型的整体性能，并在必要时计划采取纠正措施。