导航北卡罗来纳州的医疗补助转型:通过以家庭为中心的镜头来看护理人员的观点
Brittany J Raffa1, Monisa Aijaz2, Brenda Amezquita-Castro3,4
1Department of Pediatrics, The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
Journal of health services research & policy
|November 12, 2025
概括
护理人员在北卡罗来纳州的医疗补助管理护理组织 (MCO) 面临挑战,但临床工作人员的支持至关重要. 改善MCO可以提高家庭获得专业护理的机会.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 质量健康研究 质量健康研究
- 儿科健康政策 儿科健康政策
背景情况:
- 医疗补助计划至关重要,为40%的美国儿童提供保险.
- 各州正在从服务费转向医疗补助的管理护理组织 (MCO).
- 北卡罗来纳州 (NC) 在2021年将大多数医疗补助受益人转移到MCO.
研究的目的:
- 在NC医疗补助转型期间探索护理人员的经验.
- 了解儿童和护理人员在注册和获得护理方面的挑战和促进者.
- 评估MCO对家庭的影响.
主要方法:
- 定性描述性研究设计.
- 半结构面试和焦点小组与NC的19名护理人员.
- 快速定性分析,以便及时获得洞察力.
主要成果:
- 护理人员报告说,对于有复杂健康需求的家庭和非英语说话者来说,障碍增加了.
- 临床工作人员在导航系统和获得护理方面发挥了关键作用.
- 护理人员表达了对MCO的满意,尽管他们发现了一些挑战.
结论:
- 加强网络充足性标准可以改善专业护理的准入.
- 投资于为各种需求培训的MCO支持人员是必不可少的.
- 补偿临床工作人员的护理管理角色可以使家庭受益.
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