Churning the tides of care: when nurse turnover makes waves in patient access to primary care.
| Title: | Churning the tides of care: when nurse turnover makes waves in patient access to primary care. |
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| Authors: | Arredondo K; Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA. Kelley.Arredondo@bcm.edu.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. Kelley.Arredondo@bcm.edu.; VHA Office of Rural Health's Veterans Resource Center, White River Junction, USA. Kelley.Arredondo@bcm.edu.; South Central Mental Illness Research, Education, Clinical Center, a virtual center, Houston, USA. Kelley.Arredondo@bcm.edu.; Hughes AM; Department of Medicine-MetroHealth, Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Center of Innovations for Chronic, Complex Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.; Lester HF; Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.; School of Business Administration, University of Mississippi, University, MS, USA.; Pham TND; Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.; Petersen LA; Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.; Woodard L; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.; SoRelle R; Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.; Jiang CR; Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.; Oswald FL; Department of Psychological Sciences, Rice University, Houston, TX, USA.; Murphy DR; Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.; Touchett HN; Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.; South Central Mental Illness Research, Education, Clinical Center, a virtual center, Houston, USA.; Hamer J; Michael E. DeBakey VA Medical Center, Houston, TX, USA.; Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.; Hysong SJ; Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA. Sylvia.Hysong@va.gov.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. Sylvia.Hysong@va.gov. |
| Source: | BMC nursing [BMC Nurs] 2024 Oct 10; Vol. 23 (1), pp. 739. Date of Electronic Publication: 2024 Oct 10. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101088683 Publication Model: Electronic Cited Medium: Print ISSN: 1472-6955 (Print) Linking ISSN: 14726955 NLM ISO Abbreviation: BMC Nurs Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, [2002]- |
| Abstract: | Background: Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.; Objective: This study aims to empirically assess how the stability of RN staffing within team-based primary care affects patient access to care.; Methods: A retrospective database review using clinical and administrative data from the VHA over 24 months. Participants included 5,897 PC PACTs across 152 VHA healthcare facilities in the United States and its territories. The stability of personnel in the RN role was categorized as: RN continuous churn, RN staffing instability and RN vacancy. All 3 categories were compared to teams with RN stability (i.e., same person in the role for the entire 24-month period). Access measures included: average third-next-available appointment, established patient average wait time in days, urgent care utilization, emergency room utilization, and total inbound-to-outbound PC secure messages ratio.; Results: RN continuous churn within PACTs had a significant impact on third-next-available appointment (b = 3.70, p |
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| Grant Information: | R01 HS025982 United States HS AHRQ HHS; UM1 TR004528 United States TR NCATS NIH HHS; 5R01HS025982-02 Agency for Healthcare Research and Quality |
| Contributed Indexing: | Keywords: PACT; Patient aligned care teams; Primary care teams; RN; Registered nurses; Staffing stability |
| Entry Date(s): | Date Created: 20241010 Latest Revision: 20250226 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11468048 |
| DOI: | 10.1186/s12912-024-02389-8 |
| PMID: | 39390444 |
| Database: | MEDLINE |
Journal Article