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: 9927921
• 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/9927921
• 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》（《选择法案》）的要求，VHA 必须通过其学术附属办公室在未来五年内将 1,500 个新的研究生医学教育 (GME) 住院医师名额，或大约 4,500 个新住院医师安置到 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，描述他们无法填补这些新职位的原因（如果有），并报告新居民是否愿意考虑 VA 未来就业。 GME 对 VA 非常重要，因为目前三分之一的美国住院医师在 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，退伍军人管理局临床培训计划是退伍军人管理局招募医务人员的最佳手段，因为近 60% 的退伍军人管理局工作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。 2005-2010 财年，作为 2005-2010 年 GME 增强计划的一部分，OAA 增加了 1,200 个住院医师职位，涉及 3,600 名住院医师。然而，人们严重担心退伍军人管理局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 是否以及如何能够容纳各个医疗中心的 4,500 名新选择法案居民，以及面对可能上升的居民与员工比例，选择法案居民将如何为 GME 教育成果做出贡献。 GME 教育成果包括为住院医师提供获得有意义的患者护理经验的临床机会、对临床学习体验的满意度以及住院医师未来考虑其临床宿主的可能性。我们的目标是确定目前的人员配置和住院医师水平是否会增加受训人员扣除监督成本后的临床工作量。我们还评估了 2005-2010 年“外源性”GME 增强计划是否导致扩大 VA 临床机会、提高对 VA 临床学习环境的满意度，并最终提高居民的满意度。 就业能力，或者他们未来就业时考虑 VA 的意愿。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。数据通过 VA 的分配资源中心、OAA 的付费槽文件、指定学习官员的调查、VA 学员的学习者感知调查以及 VHA 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级模型来衡量 GME 增强的外生增长的影响2005-2010 年住院医生的临床工作量，以及 按专业（初级保健、精神病学和其他专业）划分的 GME 教育成果（临床机会、满意度、就业能力）以及医疗中心、住院医师和临床工作人员等特征的函数。最终工作量和结果模型的表现将被评估，并应用于模拟研究，以确定 VA 医疗中心的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，研究的时机以及与 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预测模型的整体性能，并在必要时计划采取纠正措施。