与当前或近期无家可归的退伍军人积极的初级保健经历相关的组织和患者因素。

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Stefan G Kertesz, Aerin J deRussy, April E Hoge, Allyson L Varley, Sally K Holmes, Kevin R Riggs, Erika L Austin, Adam J Gordon, Sonya E Gabrielian, David E Pollio, Ann E Montgomery, Lillian Gelberg, Jocelyn L Steward, Audrey L Jones, Joshua R Richman
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引用次数: 0

摘要

目的在为有持续和近期无家可归经历者(PEH)量身定制的初级保健诊所中,确定与患者对初级保健积极评价相关的组织服务特征:使用经过验证的无家可归者初级医疗质量(PCQ-H)调查表,对在 29 家美国退伍军人健康管理局无家可归者定制诊所接受初级医疗服务的无家可归者的初级医疗体验进行了调查。通过文献综述、实地考察、统计分析和共识商议后制定的新组织调查表,对诊所员工进行调查,评估诊所的特点:研究设计:根据对患者的调查,对患者的护理评分和诊所特征进行横断面检查,并使用分类和回归树(CART)分析(一种机器学习形式)进行分析:患者调查(n = 3394)由外部调查承包商通过邮寄和电话的方式从注册患者中随机抽样获得。通过电话采访了工作人员(n = 52,来自 29 家诊所):这项分析确定了对患者体验产生有利影响的服务特征,包括以患者为中心、团队认同感、外部领导的大力支持以及超越传统初级保健诊所范围的服务。分析的患者体验量表不同,结果也不同。PEH的个人特征,如社会支持程度、一般健康状况和无住房状况,也与他们对医疗服务的评价相关:组织特征与近期和持续无家可归的患者对初级医疗服务的评价相关。为无家可归者提供服务的初级医疗项目可以通过聘用人员、如何培养团队认同感、提供哪些服务以及领导层对保护无家可归者使命的支持力度来确保提供更好的医疗服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Organizational and patient factors associated with positive primary care experiences for veterans with current or recent homelessness.

Objective: To identify organizational service features associated with positive patient ratings of primary care within primary care clinics tailored to accommodate persons with ongoing and recent experiences of homelessness (PEH).

Data sources and study setting: PEH receiving primary care in 29 United States Veterans Health Administration homeless-tailored clinics were surveyed about their primary care experience using the validated Primary Care Quality-Homeless (PCQ-H) survey. Characteristics of the clinics were assessed through surveys of clinic staff using a new organizational survey developed through literature review, site visits, statistical analysis, and consensus deliberation.

Study design: Cross-sectional examination of patients' ratings of care based on surveys of patients, and of clinic characteristics, analyzed with Classification and Regression Tree (CART) analysis, a form of machine learning.

Data collection methods: Patient surveys (n = 3394) were obtained from a random sample of enrolled patients by both mail and telephone by an external survey contractor. Staff (n = 52 from 29 clinics) were interviewed by telephone.

Principal findings: This analysis identified service features that impact patient experience favorably, including aspects of patient-centeredness, team identity, strong external leadership support, and service that reach beyond traditional primary care clinic confines. Results varied according to the patient experience scale analyzed. Individual characteristics of PEH, such as degree of social support, general health, and unsheltered status, were also correlated with how they rate care.

Conclusions: Organizational characteristics correlate with ratings of primary care from patients with recent and ongoing homelessness. Primary care programs serving homeless individuals can assure better care based on who they hire, how they foster team identity, what services they provide, and the strength of leadership support to protect a homeless-focused mission.

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来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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