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背景和目的不按约赴诊或赴诊失约给初级保健带来收入、就诊率和病人连续性等问题。美国一都市家庭医学科住院医师教学诊所,有着数量巨大的文化背景各异、收入低下患者群。在过去的几十年里,尽管诊所试图采用多种方式提醒患者,赴诊失约率依然维持在15%~17%。本研究拟检测多元干预法在降低总赴诊失约率方面的作用。方法在履行对被服务人群的职责及确保医疗服务质量的同时,一个由临床医师和工作人员组成的小组对文献进行系统性分析,并据此找出一个能减少赴诊失约的方法。该小组采用3步过程:与反复赴诊失约次数最多的患者进行面谈;跟既往经常性赴诊失约的患者进行双次预约;改变提前预约数天或周后就诊的模式为当天预约当天就诊的模式。结果 141位(占就诊人群的2%)研究对象占赴诊失约人群的17%。这群患者与诊所总体患者群不同,大部分为享受医疗救助的女性黑人(即非裔美国人),患有多种并发症且大多都有神经方面问题。干预后,该群患者赴诊失约率从33.3%降至17.7%,全诊所总失约率从10%降至7%;这一失约率的降低在干预后33个月的观察期间一直没变,且维持至今。最大的改善发生在诊所实施当天预约当天就诊模式之后。结论先鉴别出不按约赴诊可能性较大的患者群,然后采用多元方法加以应对可持续地改进按约赴诊率,因而可在住院医生培训及社区诊所设置情况下推广应用。
Background and purpose Do not follow the principle of going to a doctor or losing an appointment to primary care to bring about income, visiting rate and patient continuity. American Metropolitan Family Medicine residency teaching clinic, with a huge number of different cultural backgrounds, low income groups of patients. In the past few decades, although clinics have tried to remind patients in various ways, the rate of missed appointments remains at 15% to 17%. This study intends to examine the role of multivariate interventions in reducing the total missed attendance rate. Methodology While performing duties on serviced persons and ensuring the quality of medical care, a team of clinicians and staff conducted a systematic analysis of the literature and found a way to reduce missed appointments. The team used a three-step process: interviews with patients with the highest number of missed appointments; double appointments with patients who missed regular appointments; and changes the mode of early appointments for days or weeks to the day of appointment mode. Results 141 (accounting for 2% of the treated population) accounted for 17% of the undetermined population on attendance. Unlike the general patient group in the clinic, the majority of these groups were female black (ie, African American) medically assisted, with multiple complications and mostly with neurological problems. After the intervention, the rate of medical failure in this group decreased from 33.3% to 17.7%, and the total failure rate of the clinic dropped from 10% to 7%. The decrease in the rate of missed outturn remained unchanged during the 33-month observation period after intervention, And maintain so far. The biggest improvement occurred after the day of appointment for the clinic on the day of the clinic’s implementation. Conclusions The first identification of patients who are not likely to be admitted to the clinic and then adopting a multi-pronged approach to respond to the continuous improvement of appointment-to-attend rates can be promoted and applied with the training of resident doctors and the setting up of community clinics.