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Outpatient provider staffing ratios: Binary recursive models associated with quality, access, and satisfaction.
Clifford A Smith1, Matthew Tyler Boden2, Jodie A Trafton2
1VHA Office of Mental Health and Suicide Prevention.
Psychological Services
|November 15, 2021
Summary
Optimizing mental health (MH) staffing is crucial for the Veterans Health Administration (VHA). This study found specific staff-to-patient ratios (SPRs) linked to better quality, access, and satisfaction in VHA MH care.
Area of Science:
- Health Services Research
- Mental Health Services
- Healthcare Workforce Management
Background:
- The Veterans Health Administration (VHA) is expanding its mental health (MH) workforce to address rising service demand.
- Understanding optimal staffing levels is critical for ensuring high-quality veteran care.
Purpose of the Study:
- To identify optimal outpatient staff-to-patient ratios (SPRs) associated with VHA's measures of mental health quality, access, and satisfaction.
- To evaluate the relationship between SPRs and key performance indicators in VHA mental health services.
Main Methods:
- Longitudinal unbiased recursive partitioning models (conditional inference trees) were employed.
- Quarterly SPRs (full-time equivalent providers per 1,000 patients) were calculated for fiscal years 2016-2018.
- Associations between SPRs and VHA quality, access, and satisfaction metrics were analyzed.
Main Results:
- An overall outpatient SPR of 7.39 was identified as a key threshold for optimal MH performance.
- Specific SPRs were linked to performance in population coverage (7.87), continuity of care (6.81), and patient experience (7.42).
- Lower SPRs correlated with lower performance, while higher SPRs correlated with higher performance.
Conclusions:
- The VHA's recommended minimum outpatient SPR of 7.72 is supported as a reasonable target.
- Achieving this SPR can contribute to high-quality mental health care, improved access, and greater patient satisfaction.
- Data-driven staffing ratios are essential for optimizing VHA mental health services.
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