流动中间护理诊所的价值与挑战:混合方法分析。

IF 1.2 Q3 HEALTH CARE SCIENCES & SERVICES
JOURNAL OF AMBULATORY CARE MANAGEMENT Pub Date : 2025-07-01 Epub Date: 2025-05-09 DOI:10.1097/JAC.0000000000000531
Seung-Yup Lee, Reid M Eagleson, Larry R Hearld, Madeline J Gibson, Allyson Hall, Michael Mugavero, Greer Burkholder, Kimberly L Payne, William M Brown, Lauren M Epp, Laurie Hunter, Corey T Spraberry, Kristine R Hearld
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引用次数: 0

摘要

背景:急诊科(ED)拥挤是卫生保健中一个持续存在的问题,导致死亡率和医疗差错增加。这一挑战在服务不足的人群中尤为明显,慢性病和ED使用率较高加剧了护理差距。为解决这一问题,必须采取系统级战略,包括建立中间护理诊所。本研究评估了美国南部护士主导的流动中间护理诊所(AICC)的前三年,重点关注其在增强护理连续性和扩展业务挑战方面的作用。方法:本研究在美国阿拉巴马州伯明翰市阿拉巴马大学伯明翰医学中心进行,采用趋同并行混合方法设计,分析了3137份AICC预约记录(2020年5月- 2023年6月)的定量数据,并对AICC工作人员进行了定性访谈。定量数据包括患者人口统计和预约特征。定性数据进行主题分析,以确定围绕AICC的利益和挑战的共同主题。结果:我们的定量分析表明,AICC管理越来越多的患者就诊与稳定的预约依从率。然而,越来越多的诊所发起的取消表明资源有限。定性研究结果为这些定量趋势提供了进一步的背景。来自少数种族群体的患者和那些有医疗补助保险的患者错过预约的几率要高得多。结果强调了AICC在预防急诊科就诊方面的价值,但也揭示了与患者的视力水平、资源分配、调度复杂性和预约依从性障碍相关的挑战。结论:建立护士主导的AICC对缓解初级保健与急症护理差距,减少急症室拥挤是可行的,也是有益的。可持续成功的关键考虑因素包括确定患者的视力阈值、简化当日转诊流程和解决能力问题。这些发现可以指导卫生系统在流动环境中实施中间护理诊所,特别是对那些服务不足的社区。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Value and Challenges of an Ambulatory Intermediate Care Clinic: A Mixed-Methods Analysis.

Background: Emergency department (ED) crowding is a persistent issue in health care, resulting in increased mortality and medical errors. This challenge is particularly pronounced in underserved populations, where a higher prevalence of chronic conditions and ED utilization exacerbates gaps in care. To address this, system-level strategies, including the establishment of intermediate care clinics, are essential. This study evaluates the first three years of a nurse-led ambulatory intermediate care clinic (AICC) in the Southern US, focusing on its role in enhancing care continuity and operational challenges for expansion.

Methods: This study, conducted at the University of Alabama at Birmingham Medical Center in Birmingham, Alabama, the United States, used a convergent parallel mixed-methods design, analyzing quantitative data from 3137 AICC appointment records (May 2020-June 2023) and conducting qualitative interviews with AICC staff members. Quantitative data included patient demographics and appointment characteristics. Qualitative data were thematically analyzed to identify common themes around AICC benefits and challenges.

Results: Our quantitative analysis showed that the AICC managed an increasing number of patient visits with a stable appointment adherence rate. However, rising clinic-initiated cancellations indicated resource limitations. Qualitative findings provided further context for these quantitative trends. Patients from racial minority groups and those with Medicaid insurance had significantly higher odds of missing appointments. The results highlighted the AICC's value in preventing ED visits but also revealed challenges related to patient acuity level, resource allocation, scheduling complexities, and appointment adherence barriers.

Conclusions: Establishing a nurse-led AICC is feasible and beneficial in alleviating the care gap between primary and acute care and reducing ED crowding. Key considerations for sustainable success include determining patient acuity thresholds, streamlining same-day referral processes, and addressing capacity issues. These findings can guide health systems in implementing intermediate care clinics in ambulatory settings, particularly for those serving underserved communities.

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来源期刊
JOURNAL OF AMBULATORY CARE MANAGEMENT
JOURNAL OF AMBULATORY CARE MANAGEMENT HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.10
自引率
4.30%
发文量
65
期刊介绍: The Journal of Ambulatory Care Management is a PEER-REVIEWED journal that provides timely, applied information on the most important developments and issues in ambulatory care management.
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