Developing a New Method to Improve Primary Care Workforce Management

开发改进初级保健劳动力管理的新方法

• 批准号: 10425164
• 负责人: KARIN M. NELSON
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425164
• 关键词: Address; Caring; Charge; Chronic Disease; Clinic; Complex; Data; Disease Management; Ensure; Equilibrium; Event; Exhibits; Foundations; Funding; Future; Goals; Health Personnel; Healthcare Systems; Home; Hour; Integrated Health Care Systems; Measures; Medical; Methodology; Methods; Modeling; Natural experiment; Nature; Nurse Practitioners; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Persons; Physician Assistants; Pilot Projects; Policies; Preventive service; Primary Care Physician; Primary Health Care; Probability; Process; Productivity; Program Evaluation; Provider; Publishing; Randomized; Recording of previous events; Reporting; Research; Secure; Services; Shock; Specialist; System; Telemedicine; Telephone; Testing; Thinness; Time; Transact; United States Department of Veterans Affairs; Update; Variant; Veterans; Visit; Work; Workload; acute care; adverse outcome; base; burnout; care coordination; care providers; contextual factors; evidence base; handbook; improved; innovation; insight; intervention program; meetings; novel; pandemic coronavirus; patient population; primary care services; programs; sound; time use; tool; video visit

Background: The Office of Primary Care (OPC) is charged with overseeing primary care in the Department of Veterans Affairs (VA). In 2010, VA primary care moved to a medical home model called the Patient Aligned Care Team (PACT). Over 5.7 million Veterans are assigned, or “empaneled”, to a primary care provider and team. Current VA panel sizes are based on historic means and there are concerns that these metrics should be updated given high rates of burnout among primary care providers. However, the evidence base is thin, and a recent a recent HSR&D Evidence Synthesis Program (ESP) report calls for greater evidence to manage the primary care work force of 7,995 primary care physicians and providers (PCP). Significance/Impact: This study will assist the VA with managing its primary care workforce to balance the needs for efficiency and the wellness of the workforce. The novel methods in this study will set the stage for future randomized program evaluations that can test ways to improve efficiency and outcomes for providers and patients. Innovation: The goal of the proposed study is to provide foundational evidence on primary care panel size by adapting and extending a recently developed methodology to assess the workload of primary care patients. The results of this study have a high probability of immediate impact in the VA by informing primary care work force management, in addition to providing evidence that longitudinal patient histories can be used to estimate time and workload for primary care panels. Specific Aims: Aim 1: To describe weekly demand, weekly capacity, and weekly overflow (i.e., demand > capacity) for every PCP and how these parameters vary by PCP, by team, by clinic and by health care system. Aim 2: To determine whether system-level funding is associated with PCP overflow. We will examine the association between the system funding and PCP overflow. Aim 3: To identify which patient events are leading to overflow. This aim examines random variation in weekly patient flow to determine whether random “shocks” in patient events are leading to overflow. Aim 4: To examine overflow in relation to workforce health, measured by provider burnout and turnover. Methodology: The proposed study extends a recently developed methodology to assess the workload of primary care patients and use this workload to develop time estimates for caring for populations of patients. This approach, recently published by Rossi et al. (2018), uses longitudinal data to enumerate patient-related events, or transactions, including both face to face visits and non-face to face care. These transactions are then combined with time estimates per transaction to determine the time it would take to care for a panel of patients. The method provides information on the flow of patients and the demand on primary care providers, and allows for calculation of overflow, where demand would exceed capacity to supply services. We have piloted this method in one health care system in VA and have demonstrated the feasibility of using this method for VA data and have calculated plausible estimates for overflow hours. Implementation/Next steps: The current proposal builds a methodology for tracking panel management. These results have implications for primary care workforce management in VA and other large integrated health systems. It will be through future randomized program evaluations, in combination with the tools we are building, that we will be able to understand the causal effects of policies on PCP productivity, while tracking adverse outcomes.

背景：初级保健办公室 (OPC) 负责监督卫生部的初级保健 退伍军人事务部（VA）。 2010 年，VA 初级保健转向名为“患者对齐”的医疗之家模式 护理团队 (PACT)。超过 570 万退伍军人被分配或“分派”给初级保健提供者和 团队。目前的 VA 面板尺寸基于历史平均值，有人担心这些指标应该 鉴于初级保健提供者的倦怠率很高，需要进行更新。然而，证据基础薄弱，并且 最近的 HSR&D 证据综合计划 (ESP) 报告呼吁提供更多证据来管理 由 7,995 名初级保健医生和提供者 (PCP) 组成的初级保健劳动力。 意义/影响：本研究将帮助 VA 管理其初级保健人员，以平衡 对效率和员工健康的需求。本研究中的新颖方法将为 未来的随机计划评估可以测试提高提供者效率和结果的方法 和病人。 创新：拟议研究的目标是通过以下方式提供初级保健小组规模的基础证据： 调整和扩展最近开发的方法来评估初级保健患者的工作量。 这项研究的结果很有可能通过为初级保健工作提供信息而对退伍军人管理局产生直接影响 力管理，除了提供证据表明纵向患者病史可用于估计 初级保健小组的时间和工作量。 具体目标： 目标 1：描述每周需求、每周容量和每周溢出（即需求 > 每个 PCP 的容量）以及这些参数如何随 PCP、团队、诊所和医疗保健系统的不同而变化。 目标 2：确定系统级资金是否与 PCP 溢出相关。我们将检查 系统资金和 PCP 溢出之间的关联。目标 3：确定哪些患者事件是 导致溢出。该目的检查每周患者流量的随机变化，以确定是否随机 患者事件的“冲击”正在导致溢出。目标 4：检查与劳动力健康相关的溢出， 通过供应商倦怠和营业额来衡量。 方法：拟议的研究扩展了最近开发的方法来评估工作量 初级保健患者，并利用此工作量来估算护理患者群体的时间。 这种方法最近由 Rossi 等人发表。 （2018），使用纵向数据来列举与患者相关的 事件或交易，包括面对面的访问和非面对面的护理。这些交易是 然后结合每笔交易的时间估计来确定处理一组数据所需的时间 患者。该方法提供有关患者流动和初级保健提供者需求的信息， 并允许在需求超出服务供应能力的情况下计算溢出。我们有 在 VA 的一个医疗保健系统中试点了该方法，并证明了使用该方法的可行性 VA 数据并计算了溢出时间的合理估计。 实施/后续步骤：当前提案构建了跟踪小组管理的方法。 这些结果对 VA 和其他大型综合性机构的初级保健劳动力管理具有影响 卫生系统。这将通过未来的随机计划评估并结合我们现有的工具来实现 建立，我们将能够了解政策对 PCP 生产力的因果影响，同时跟踪 不良后果。