Evaluation of a Professional Practice Model in the Ambulatory Care Setting
Final rept. 1 Sep 2010-31 Aug 2013
GENEVA FOUNDATION TACOMA WA
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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. SampleMethods Nursing staff n42 and patients n1220 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 n2834 and the Interactive Customer Evaluation n4275 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. AnalysisFindings Communication p-.004, accessconvenience 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, RNMD relationships improved F2, 85 19.2, p .05 in both clinics. Few quality care metrics improved in either FM n2 or IM n3. 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.
- Administration and Management
- Personnel Management and Labor Relations
- Medicine and Medical Research