关于加利福尼亚医疗补助计划患者护理障碍的前线观点:一项定性研究
Jessica Faiz1,2, Mariah Blegen3,4, Vanessa Nuñez5
1National Clinician Scholars Program, VA Greater Los Angeles Healthcare System and UCLA, 1100 Glendon Ave., Ste. 1100, 90024, Los Angeles, CA, USA. jfaiz@mednet.ucla.edu.
International journal for equity in health
|May 22, 2024
概括
由于系统层面的问题,Medi-Cal患者无法获得门诊护理,包括保险复杂性和信息流动不良. 解决这些障碍需要进行多层次的改革,以改善患者获取和减少提供者的道德伤害.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
- 质量健康研究 质量健康研究
背景情况:
- 仅靠保险覆盖,就不能保证美国的医疗保健,特别是对于公共保险的个人来说.
- 医疗补助 (加利福尼亚州的Medi-Cal) 受益人面临由于健康的社会决定因素,管理护理复杂性和政策层面的因素而造成的进入障碍.
- 了解卫生系统层面的障碍对于开发可持续解决方案以改善医疗保健准入至关重要.
研究的目的:
- 调查Medi-Cal.保险的患者获得门诊护理的障碍.
- 确定在学术医疗中心环境中改善医疗保健准入的机会.
- 了解管理护理对患者获取和提供者工作流程的影响.
主要方法:
- 在一个大型学术医疗中心,使用与临床医生和行政人员 (n=19) 的半结构面试进行了定性研究.
- 采访重点关注获得护理的四个关键步骤:安排,转诊/授权,签订合同和临床接触.
- 采访数据被转录和归纳编码,以确定与访问障碍和改进机会相关的主题.
主要成果:
- 工作人员报告了障碍,包括缺乏对系统政策的认识,复杂的保险合同,社会支持资源不足和信息传播不佳.
- 与收费服务相比,管理的Medi-Cal对员工施加了额外的时间和精力,导致护理延迟,协调分散,以及不理想的患者护理.
- 发现的关键问题包括系统层面的政策缺口,授权不一致性,有限的安排和社会工作支持,以及不充分的提供者-患者信息交换.
结论:
- 系统层面的政策,保险授权流程,支持服务的资源配置和信息流存在重大差距,阻碍Medi-Cal患者获得护理.
- 医疗保健提供者经历了道德伤害,因为系统性缺陷导致患者护理延迟.
- 需要涉及国家,保险组织和机构的多层次改革,以解决Medi-Cal创新努力中的这些进入障碍.
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