Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics.
MISSION Act
Patient satisfaction
Productivity
Scribes
Veterans
Wait times
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
14
06
2022
accepted:
23
02
2023
medline:
21
7
2023
pubmed:
21
6
2023
entrez:
20
6
2023
Statut:
ppublish
Résumé
Section 507 of the VA MISSION Act of 2018 mandated a 2-year pilot study of medical scribes in the Veterans Health Administration (VHA), with 12 VA Medical Centers randomly selected to receive scribes in their emergency departments or high wait time specialty clinics (cardiology and orthopedics). The pilot began on June 30, 2020, and ended on July 1, 2022. Our objective was to evaluate the impact of medical scribes on provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act. Cluster randomized trial, with intent-to-treat analysis using difference-in-differences regression. Veterans using 18 included VA Medical Centers (12 intervention and 6 comparison sites). Randomization into MISSION 507 medical scribe pilot. Provider productivity, wait times, and patient satisfaction per clinic-pay period. Randomization into the scribe pilot was associated with increases of 25.2 relative value units (RVUs) per full-time equivalent (FTE) (p < 0.001) and 8.5 visits per FTE (p = 0.002) in cardiology and increases of 17.3 RVUs per FTE (p = 0.001) and 12.5 visits per FTE (p = 0.001) in orthopedics. We found that the scribe pilot was associated with a decrease of 8.5 days in request to appointment day wait times (p < 0.001) in orthopedics, driven by a 5.7-day decrease in appointment made to appointment day wait times (p < 0.001), and observed no change in wait times in cardiology. We also observed no declines in patient satisfaction with randomization into the scribe pilot. Given the potential improvements in productivity and wait times with no change in patient satisfaction, our results suggest that scribes may be a useful tool to improve access to VHA care. However, participation in the pilot by sites and providers was voluntary, which could have implications for scalability and what effects could be expected if scribes were introduced to the care process without buy-in. Cost was not considered in this analysis but is an important factor for future implementation. ClinicalTrials.gov Identifier: NCT04154462.
Sections du résumé
BACKGROUND
Section 507 of the VA MISSION Act of 2018 mandated a 2-year pilot study of medical scribes in the Veterans Health Administration (VHA), with 12 VA Medical Centers randomly selected to receive scribes in their emergency departments or high wait time specialty clinics (cardiology and orthopedics). The pilot began on June 30, 2020, and ended on July 1, 2022.
OBJECTIVE
Our objective was to evaluate the impact of medical scribes on provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act.
DESIGN
Cluster randomized trial, with intent-to-treat analysis using difference-in-differences regression.
PATIENTS
Veterans using 18 included VA Medical Centers (12 intervention and 6 comparison sites).
INTERVENTION
Randomization into MISSION 507 medical scribe pilot.
MAIN MEASURES
Provider productivity, wait times, and patient satisfaction per clinic-pay period.
KEY RESULTS
Randomization into the scribe pilot was associated with increases of 25.2 relative value units (RVUs) per full-time equivalent (FTE) (p < 0.001) and 8.5 visits per FTE (p = 0.002) in cardiology and increases of 17.3 RVUs per FTE (p = 0.001) and 12.5 visits per FTE (p = 0.001) in orthopedics. We found that the scribe pilot was associated with a decrease of 8.5 days in request to appointment day wait times (p < 0.001) in orthopedics, driven by a 5.7-day decrease in appointment made to appointment day wait times (p < 0.001), and observed no change in wait times in cardiology. We also observed no declines in patient satisfaction with randomization into the scribe pilot.
CONCLUSIONS
Given the potential improvements in productivity and wait times with no change in patient satisfaction, our results suggest that scribes may be a useful tool to improve access to VHA care. However, participation in the pilot by sites and providers was voluntary, which could have implications for scalability and what effects could be expected if scribes were introduced to the care process without buy-in. Cost was not considered in this analysis but is an important factor for future implementation.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04154462.
Identifiants
pubmed: 37340268
doi: 10.1007/s11606-023-08114-6
pii: 10.1007/s11606-023-08114-6
pmc: PMC10356725
doi:
Banques de données
ClinicalTrials.gov
['NCT04154462']
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
878-886Informations de copyright
© 2023. The author(s).
Références
Health Informatics J. 2021 Jan-Mar;27(1):1460458217692930
pubmed: 29239230
Acad Pediatr. 2021 Apr;21(3):542-547
pubmed: 32445825
J Am Board Fam Med. 2018 Jul-Aug;31(4):612-619
pubmed: 29986987
J AHIMA. 2012 Nov-Dec;83(11):64-9
pubmed: 23210302
JAMA. 2022 Oct 4;328(13):1350-1352
pubmed: 36048452
Arthrosc Sports Med Rehabil. 2022 Apr 08;4(3):e997-e1005
pubmed: 35747641
JAMA Intern Med. 2018 Nov 1;178(11):1467-1472
pubmed: 30242380
Data Brief. 2021 May 14;36:107134
pubmed: 34095383
Ann Fam Med. 2017 Sep;15(5):427-433
pubmed: 28893812
BMC Health Serv Res. 2021 Jul 11;21(1):686
pubmed: 34247600
JAMA. 2017 Mar 7;317(9):901-902
pubmed: 28196201
Clinicoecon Outcomes Res. 2013 Aug 09;5:399-406
pubmed: 23966799
J Gen Intern Med. 2020 May;35(5):1382-1388
pubmed: 32096080
Contemp Clin Trials. 2021 Jul;106:106455
pubmed: 34048944
Ann Otol Rhinol Laryngol. 2020 Mar;129(3):238-244
pubmed: 31640405
J Gen Intern Med. 2018 Jul;33(7):1109-1115
pubmed: 29700790
World J Urol. 2018 Oct;36(10):1691-1697
pubmed: 29637266
J Emerg Med. 2021 Jul;61(1):19-28
pubmed: 34006414
J Fam Pract. 2021 May;70(4):166-203
pubmed: 34339359
Am J Emerg Med. 2017 Feb;35(2):311-314
pubmed: 27856140
Rand Health Q. 2016 May 9;5(4):14
pubmed: 28083424
Ann Emerg Med. 2021 Feb;77(2):180-189
pubmed: 32868143
JAMA. 2019 Feb 19;321(7):635-636
pubmed: 30778589
Am J Med Qual. 2014 May-Jun;29(3):227-35
pubmed: 23939488