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跨机构推的障碍和促进者:VA员工经验的系统配置分析
April Savoy1,2,3, Frances M Weaver4,5, Himalaya Patel6,7
1Center for Health Information and Communication (CIN 13-416), Health Systems Research, Richard L. Roudebush Department of Veterans Affairs (VA) Medical Center, Indianapolis, IN, USA. asavoy@purdue.edu.
新的美国退伍军人健康管理局 (VA) 政策旨在改善退伍军人护理转诊. 然而,工作人员在信息共享,技术和机构间关系方面发现了重大障碍,导致护理延迟和工作量增加.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 系统工程 系统工程
- 医疗保健政策 医疗保健政策
背景情况:
- 最近的美国立法,包括退伍军人准入,选择和问责法案 (选择法案) 和维护内部系统和加强集成外部网络法案 (使命法案),扩大了退伍军人的医疗保健选择.
- 这些政策变化促进了美国退伍军人在退伍军人卫生管理局 (VA) 内的跨机构转诊.
研究的目的:
- 确定影响跨机构门诊转诊患者信息共享的关键促进者和障碍.
- 了解最近的政策变化如何影响这些信息共享动态.
主要方法:
- 利用患者安全系统工程倡议 (SEIPS) 2.0框架进行分析.
- 在6个VA设施社区护理联络计划办公室与临床和行政人员进行了半结构化采访.
- 采用工作系统和配置分析,包括使用配置图进行定向内容分析和可视化.
主要成果:
- 标志着一个由九个步骤组成的临时推过程,在安排,协调和记录传输 (访问前和后) 中发现了障碍.
- 常见的障碍包括低技术采用,与社区护理网络 (CCN) 临床医生关系紧张以及不一致的政策.
- 环境因素,如COVID-19大流行和第三方管理员过渡加剧了挑战.
结论:
- 由于信息共享的社会和技术障碍,VA工作人员报告说患者护理延迟和工作量增加.
- 该研究确定了技术,人员和组织作为主要的工作系统因素,有助于推障碍.
- 建议在系统层面进行干预,以改善机构间关系,规范信息交换政策,增强通信技术.
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