简而言之: 在以团队为基础的护理模式中,所有 bet8网站备用领导的团队成员 在提供方面发挥不可或缺的作用 病人护理.
到2035年,患有心血管疾病的美国人 会上升到1.3亿多吗. 这种增加的需求将使心血管疾病的总护理费用增加一倍, 每年花费超过1万亿美元.
管理成本, payers are likely to increase pressure on health systems and providers to deliver more targeted, 贯穿病人整个生命周期的个性化护理, 重点是及时获得高质量的护理和结果.
二月是美国心脏月, and this article explores several factors contributing to the current shortage of cardiology providers and encourages cardiovascular (CV) program leaders to consider team-based care models a strategic imperative.
心脏病学劳动力压力点
Many cardiology practices across the country are experiencing demand levels that push appointment wait time far beyond recommended benchmarks. 老龄化的简历大军, 供应商职业倦怠的持续影响, 执业心脏病专家数量不足, and increasing subspecialization are all key factors contributing to a misalignment of CV providers and the demand for care. Healthcare leaders need to address these current workforce trends to avoid further deterioration of patient access over the next decade.
老化的劳动力
More than a quarter of cardiologists in the US are over the age of 61, and more than 60% are 55岁以上. 心脏病学在所有亚专科都有很高的随叫随到负担, 除了随叫随到, procedural subspecialties experience the physical demand of standing for long hours in interventional labs wearing heavy lead aprons. 而许多心脏病专家一直工作到70多岁, 在完全退休前的几年,通常会有一段减速期, in which cardiologists transition to a reduced clinical schedule over the span of a decade.
提供者倦怠
Provider burnout was an issue before COVID-19; the pandemic only amplified the problem. A 美国心脏病学会(ACC)进行的一项调查显示) noted that self-reported burnout was at 20% among cardiologists prior to the pandemic and nearly doubled to 38% at its peak. The additional stress experienced by the cardiology workforce may accelerate retirement and initiate more pre-retirement slowdowns.
供应不足
随着对心血管护理的需求持续攀升, 美国预计,进入劳动力市场的新心脏病专家将出现短缺. Estimates of the severity of this shortfall vary but represent an alarming number, especially given that even a one-for-one replacement would be inadequate to meet demand. 另外, 因为越来越多的早期心脏病专家被人口较多的城市所吸引, the limited availability of cardiologists is disproportionately impacting rural and underserved communities.
Subspecialization
A growing number of cardiology fellows now pursue additional subspecialty training, 这可能会减少获得普通心脏病治疗的机会. 有几个因素推动了这种细分的增加:
- Rapidly advancing therapies and technology are creating the need for cardiologists to narrow their field of practice to remain current and maintain technical skills.
- 微创技术的进展, catheter-based therapies require a greater amount of time in interventional labs, 减少可用的门诊时间.
- 尽管基于价值的护理模式广泛出现, many cardiology compensation plans are still predominantly constructed around RVU-based productivity, 推动了一种倾向于程序性专业而不是E&由普通心脏病专家提供的基于m的bet8娱乐.
以团队为基础的护理解决方案
While several factors are contributing to a current shortage of cardiology providers, CV program leaders should consider team-based care models a strategic imperative. 团队-based care is a strategic redistribution of work among members of a practice team. 在这个模型中, all bet8网站备用领导的团队成员 在提供方面发挥不可或缺的作用 病人护理.
While there are some considerations for variations in licensing and practice across states, a nurse practitioner (NP) or physician assistant (PA) can provide the equivalent of a full-time physician managing established and post-discharge patients in an ambulatory clinic. This does not require an independent practice model for the advanced practice provider (APP) team. Rather it is a thoughtfully defined partnership between two to four cardiologists and an APP practicing at the top 他们的执照.
除了扩大病人获得治疗的机会, 一个设计良好的, 以团队为基础的护理模式也可以改善护理协调和患者参与.
循证护理途径推动护理协调
在高效的团队护理模式中,门诊APP遇到 是否通过护理途径进行管理. 这些途径是协同建立的 与护理小组的心脏病学成员一起为特定的患者群体bet8娱乐. 例如心力衰竭、冠状动脉疾病、心房颤动、 以及术后护理.
护理路径将指定后续行动的时间框架 visits, including which provider the patient should see and at what time intervals, 以及针对特定患者群体的基本护理管理方案.
团队关怀“豆荚”
成功地优化护理的可及性和连续性 在这种模式下,APP fte必须完全致力于门诊bet8娱乐 和一个由2到4名心脏病专家组成的小组合作. 通常这些“豆荚”是 围绕亚专科(介入心脏病学、心电学、普通科)设计 心脏病等.). 每位心脏病专家都参与了护理的设计 路径为pod的APP成员,并支持一致使用 病人的路径. 这有助于确保APP的成功,因为他们 照顾和管理心脏病专家小组的病人.
角色特定的职责和工作描述应该起到指导作用 work distribution among the team and ensure each provider is working at the top 他们的执照. 图1提供了描述共享目标和 在以团队为基础的护理模式中,明确患者护理的角色. 新员工培训和 培训新团队成员对于确保每个提供者理解非常重要 他们在照顾病人中的作用以及他们如何与其他成员互动 护理团队.
重要的是,APP假设有一个完整的诊所时间表 入院和出院后的病人,必须给予相同的待遇 作为心脏病专家的支持水平. 图2提供了一个示例,但是 有许多混合选择来设计FTE的组成和分配 心脏科团队护理模式.
调度模板由适当的提供商提供适当的bet8娱乐
Clinic scheduling templates are a critical component of success in the team-based care model. Well-designed templates ensure that patients are seen at the right time by the right provider, and that cardiologists and APPs are fully utilized and operating at the top of license.
Clinic schedules should be open and available for scheduling a minimum of six months in advance, 最好是一年. Templates and scheduling rules should be straightforward, clear, and consistent for schedulers.
- Each cardiologist should have dedicated new patient appointment slots each day to achieve a goal of three to five days for time to new patient appointment.
- APP schedules should be fully utilized for established patients with slots reserved daily to accommodate post-discharge patients, 基于历史的需求,在实践中.
价值主张
成功的以团队为基础的护理模式在财务上是可行的 可持续发展的. 图3提供了一个使用 30分钟访问模板. 与三位心脏病专家合作,APP can function as a full-time provider with a schedule that accommodates approximately 每年3,200人次*如下图所示. 经常E&M计费完全可以 支持APP FTE的成本. 对于三位心脏病专家来说,这是 may net up to 1,000 open slots annually for new patients, making the team-based care model a financially 可持续发展的 means to expand access, grow patient panel 大小,更好地管理患者的结果.
实施基于团队的护理模式
Establishing team-based care models is a creative and cost-effective way to address the multitude of provider workforce and patient access challenges CV programs are currently facing. 当实施有效时, 一个设计良好的 team-based care model improves 护理协调和患者参与, 增加患者获得护理的机会, 并允许每个供应商在他们的许可证的顶部工作. Utilizing evidence-based care pathways and clearly delineating clinical responsibilities will foster collaboration among team members and ultimately drive success.
你的CV项目是否难以获得患者?
学习心电图 能帮助你过渡到一个高效、现代、基于团队的模式吗.
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出版于2023年2月15日