Linnaea Schuttner1,2, Eric Gunnink3, Philip Sylling4, Leslie Taylor3, Stephan D Fihn5, Karin Nelson3,5. 1. VA Puget Sound Health Care System Health Services Research & Development, Seattle, WA, USA. linnaea.schuttner@va.gov. 2. Department of Medicine, University of Washington, Seattle, WA, USA. linnaea.schuttner@va.gov. 3. VA Puget Sound Health Care System Health Services Research & Development, Seattle, WA, USA. 4. King County Department of Community and Human Services, Seattle, WA, USA. 5. Department of Medicine, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: Following implementation of the patient-centered medical home (PCMH) within the Department of Veterans Affairs (VA), access to primary care improved. However, understanding of how this occurred is lacking. OBJECTIVE: To examine the association between organizational aspects of the PCMH model and access-related initiatives with patient perception of access to urgent, same-day, and routine care within the VA. DESIGN: Cross-sectional PARTICIPANTS: Veterans who responded to the annual Survey of Healthcare Experiences of Patients in 2016 (N = 241,122 patients) and primary staff who responded to VA National Primary Care Provider and Staff Survey (N = 4815 staff). MAIN MEASURES: Three outcomes of perception of access: percentage of patients responding in the highest category for same-day care (waiting ≤ 1 day), urgent care (always receiving care when needed), and routine care (always receiving checkups when desired). Predictors were staff-level report of access-related initiatives and organizational factors in the clinic. We used generalized estimating equations to model associations, adjusting for characteristics of patients and their respective clinics. KEY RESULTS: Access was significantly better in clinics where staff reviewed performance reports (+ 0.9% in the highest perception of access for urgent care, P < 0.01; + 1.2% for routine care, P < 0.001), leadership was supportive of the PCMH (+ 1.6% for urgent care, P < 0.01), and initiatives to improve access included open access (+ 0.8% to + 1.7% across all outcomes, P < 0.01) and telehealth visits (+ 1.2% to + 1.4%, P < 0.001). Perceived access was worse in clinics with moderate staff burnout (- 1.1% to - 1.4%, P < 0.001), primary care provider turnover during the past year (- 1.0% to - 1.6%, P < 0.001), or medical support assistant turnover in the past year (- 0.9% to - 1.4%, P < 0.001). CONCLUSIONS: Perception of access was strongly associated with identifiable organizational factors and access-related initiatives within VA primary care clinics that could be adopted by other health systems.
BACKGROUND: Following implementation of the patient-centered medical home (PCMH) within the Department of Veterans Affairs (VA), access to primary care improved. However, understanding of how this occurred is lacking. OBJECTIVE: To examine the association between organizational aspects of the PCMH model and access-related initiatives with patient perception of access to urgent, same-day, and routine care within the VA. DESIGN: Cross-sectional PARTICIPANTS: Veterans who responded to the annual Survey of Healthcare Experiences of Patients in 2016 (N = 241,122 patients) and primary staff who responded to VA National Primary Care Provider and Staff Survey (N = 4815 staff). MAIN MEASURES: Three outcomes of perception of access: percentage of patients responding in the highest category for same-day care (waiting ≤ 1 day), urgent care (always receiving care when needed), and routine care (always receiving checkups when desired). Predictors were staff-level report of access-related initiatives and organizational factors in the clinic. We used generalized estimating equations to model associations, adjusting for characteristics of patients and their respective clinics. KEY RESULTS: Access was significantly better in clinics where staff reviewed performance reports (+ 0.9% in the highest perception of access for urgent care, P < 0.01; + 1.2% for routine care, P < 0.001), leadership was supportive of the PCMH (+ 1.6% for urgent care, P < 0.01), and initiatives to improve access included open access (+ 0.8% to + 1.7% across all outcomes, P < 0.01) and telehealth visits (+ 1.2% to + 1.4%, P < 0.001). Perceived access was worse in clinics with moderate staff burnout (- 1.1% to - 1.4%, P < 0.001), primary care provider turnover during the past year (- 1.0% to - 1.6%, P < 0.001), or medical support assistant turnover in the past year (- 0.9% to - 1.4%, P < 0.001). CONCLUSIONS: Perception of access was strongly associated with identifiable organizational factors and access-related initiatives within VA primary care clinics that could be adopted by other health systems.
Authors: Sarah Hudson Scholle; Oanh Vuong; Lin Ding; Stephanie Fry; Patricia Gallagher; Julie A Brown; Ron D Hays; Paul D Cleary Journal: Med Care Date: 2012-11 Impact factor: 2.983
Authors: Usha Subramanian; Ronald T Ackermann; Edward J Brizendine; Chandan Saha; Marc B Rosenman; Deanna R Willis; David G Marrero Journal: J Gen Intern Med Date: 2009-01-09 Impact factor: 5.128
Authors: Ann-Marie Rosland; Karin Nelson; Haili Sun; Emily D Dolan; Charles Maynard; Christopher Bryson; Richard Stark; Joanne M Shear; Eve Kerr; Stephan D Fihn; Gordon Schectman Journal: Am J Manag Care Date: 2013-07-01 Impact factor: 2.229