门诊中介护理诊所的价值和挑战:混合方法分析
Seung-Yup Lee1, Reid M Eagleson, Larry R Hearld
1Author Affiliations: Center for Outcomes and Effectiveness Research and Education (Mr Eagleson, Ms Gibson, Dr Mugavero), Department of Health Services Administration (Drs Lee, Hall, Hearld, and Hearld), The University of Alabama at Birmingham, Birmingham, Alabama, Department of Medicine (Drs Burkholder and Brown), Clinical Operations (Ms Payne), Advance Practice Provider (Ms Epp), Ambulatory Services (Ms Hunter), Business Operations (Dr Sprayberry), UAB Medicine, Birmingham, Alabama.
一个由护士领导的门诊中介护理诊所 (AICC) 在减少急诊室 (ED) 拥挤和改善服务不足的人群的护理连续性方面显示出可行性. 主要挑战包括资源限制和某些患者群体的预约遵守障碍.
科学领域:
- 医疗保健管理的管理
- 健行护理服务提供者
- 医疗保健服务研究 医疗服务研究
背景情况:
- 应急部门 (ED) 拥挤是一个关键的医疗保健问题,不成比例地影响着服务不足的人群,并导致不良结果.
- 系统层面的干预,如中间护理诊所,对于解决护理缺口和ED过度拥挤至关重要.
- 本研究研究了美国南部一家由护士领导的门诊中介护理诊所 (AICC) 的前三年.
研究的目的:
- 评估护士领导的AICC在提高护理连续性的有效性.
- 确定AICC扩张的运营挑战和机会.
- 评估AICC对减少急诊室使用率的影响.
主要方法:
- 采用了融合的并行混合方法设计.
- 对3137个AICC预约记录 (2020年5月至2023年6月) 的定量分析,包括患者人口统计和预约特征.
- 对员工采访进行定性主题分析,以确定好处和挑战.
主要成果:
- AICC显示,患者访问量增加,坚持稳定,但取消的数量增加表明资源限制.
- 来自种族少数群体的患者和那些有医疗补助保险的患者显示出更高的错过预约率.
- 在预防ED访问方面,AICC被证明是有价值的,但在患者敏性,资源,安排和遵守方面面临挑战.
结论:
- 由护士领导的AICC是可行的,有利于弥合初级和急性护理的差距,并减轻ED拥挤.
- 可持续的成功需要定义患者敏度值,优化转诊流程和解决能力.
- 研究结果为实施门诊中介护理诊所提供了指导,特别是在服务不足的社区.
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