Evaluation of a Professional Practice Model in the Ambulatory Care Setting.

摘要

Purpose: Explore effects of implementing a professional practice model (PPM) on optimum care indices in two military ambulatory clinics. Design: This 2 x 3 fixed factorial design examined 32 access, continuity, staff and patient satisfaction, and quality care indices in Family (FM) and Internal Medicine (IM) clinics across three time periods. Sample/Methods: Nursing staff (n=42) and patients (n=1220) were recruited using non-purposive sampling for the satisfaction questionnaires. Aggregated quality care, access, and continuity metrics from each clinic and selected questions from the Army Provider Level Satisfaction Survey (n=2834) and the Interactive Customer Evaluation (n=4275) were analyzed using descriptive and inferential statistics. Qualitative data from questionnaires were analyzed using content analysis, identifying points convergence, divergence, and complementarity with quantitative data. Analysis/Findings: Communication (p-.004), access/convenience (p=.001), see provider when needed (p=.039) and overall satisfaction (p=.015) improved over time. Patient satisfaction was more favorable in FM than IM (Wilk s = .982, p= .001). Staff satisfaction improved in FM (p .05) only, RN/MD relationships improved (F(2, 85) = 19.2, p .05) in both clinics. Few quality care metrics improved in either FM (n=2) or IM (n=3_. Qualitatively, staff identified significant work turbulence: frequent changes, lack of resources, ineffective leadership communication, management style, staffing, and practice constraints as issues. Furthermore, Patient Centered Medical Home (PCMH) implementation eclipsed PPMs, as nursing staff felt excluded from decision-making. Staff dissatisfaction was mirrored in the patient comments, as patients felt rushed, commenting that staff needed more help.