Effect of Closure of a Local Safety- Net Hospital on Primary Care Physicians’ Perceptions of Their Role in Patient Care. Abstract. PURPOSE We examined how the closure of a large safety- net hospital in Los Angeles County, California, affected local primary care. Two investigators independently reviewed and coded transcripts. Three investigators used pile- sorting. Three major themes emerged. There is a need for greater. The closure resulted in the loss of. The transition plan involved transferring. ![]() In addition, there was an impact on faculty. For this reason and because studies have shown how primary. MEB Closure; Manoa Green Days; Power Down Checklist. The department of Pediatrics is committed to providing a comprehensive program of training. Visit our Pediatrics Residency Program homepage at. ![]() CAB) decided. to explore the physicians’ perspectives on the hospital’s closure. We used community input to conduct a qualitative study of the physicians’ perceptions of the closure. The Journal of Pediatrics and The Journal of Allergy and Clinical Immunology are pleased to announce a shared science program. Www.virology-education.com Program 5 International Workshop on HIV Pediatrics Kuala Lumpur, Malaysia 28 - 29 June 2013 th Biltstraat 106 3572 BJ Utrecht the Netherlands www.virology-education.com. Program Requirements for Residency Education in the Subspecialties of Pediatrics Program Requirements for. The ABP has established a policy for a closure date. Effect of Closure of a Local Safety-Net Hospital on Primary Care Physicians’ Perceptions of Their Role in Patient Care. 3 Robert Wood Johnson Clinical Scholars Program. 17% were in pediatrics. ![]() ![]() Our objectives were. The advisory board was convened from separate. South Los Angeles. Each representative had a particular contribution. Although. this particular board did not have an independent function, they have worked together on similar advocacy issues in the past. They reviewed the final interview. They reviewed initial themes midway through study interviews and helped. CAB members also brought the findings back to their respective organizations. We did purposeful quota sampling of physicians by race/ethnicity and equally included those from underserved and. The practice setting was defined as underserved if it was a federally qualified community health. Health Profession Shortage Area by the Health Resources and Service Administration. We. also categorized physicians by distance to the closed hospital using a 1. Los Angeles County public health systems. To mitigate selection bias, we limited the number of referrals to fewer than 4 per CAB member or participant and excluded. Of the 2. 6 individuals referred by the CAB, 1. In the third wave, we interviewed 7 physicians who fulfilled the study criteria. ![]() Each potential participant. Overall. of 5. 7 individuals referred for open interview slots, 4 were ineligible and 1. Interviews were conducted from March through September 2. During. the 1- hour semistructured interviews, we asked the physicians open- ended questions about how the closure of MLK Hospital affected. The RAND Institutional. Review Board approved the study protocol. Two investigators (K. O. W. Specifically, transcripts were read several times in an iterative process to identify. These concepts were. After independently coding transcripts. Within each grouping, we selected. Three investigators (K. O. W., R. C.. and A. F. B.) then reviewed the subthemes for relevancy and consistency as the overarching themes emerged on hospital closure. We then reviewed the themes with the CAB and agreed on the overarching categories. We compared. the responses of physicians who practiced in under- served settings in Los Angeles County with those of physicians who practiced. We also compared responses between those who practiced 1. Atlas. ti software version 5. Atlas. By specialty, 4. The mean distance to MLK Hospital was considerably closer for physicians in underserved settings (9. Overall, two- thirds (2. Figure 2). The vast majority of physicians in underserved settings, 1. Below, we report the most salient subthemes and. Table 2) and numbers of physicians who described each effect (Table 3). The subthemes that emerged were. The strain on the region’s resources was experienced more acutely by physicians working in underserved settings, but a. Geographically, the effects were more common. One physician noted how limited specialty consultations were: “Specialty care has been. Similarly, referrals for elective. As a physician explained, “Elective. It is virtually impossible to get a schedule. The wait lists are just insane” . Because of the prolonged time until admission and the greater. The system isn’t allowing them to get into a . One physician offered the following assessment: So this particular area has a lot of needs for emergency services as well as trauma. So those particular problems that you. I mean the immediate effect is the hospitals. Of the 1. 1 physicians (2. Table 3). Physicians reported seeing sicker patients, which several attributed to patients delaying care for various reasons including. One physician mentioned. We do see more. emergency surgeries on uninsured patients here because they’re waiting in that queue and they have cholelithiasis and then. The interviewed physicians noted substantial confusion for patients in identifying. One internist believed this confusion disrupted his continuity of care: “. As described by one: “So you have the patients come in every 3. If you’re not really, really sick, we can’t put you in a primary. This theme predominantly affected physicians who worked within the network of the closed safety- net hospital. Fifteen (3. 6%) of the interviewed physicians described. Table 3). Eight physicians described physician work- force losses that started with gradual attrition of faculty from training programs. MLK Hospital in the years before closure from multifactorial causes including productivity concerns, residency accreditation. Of note, some of the changes related to residency program closure occurred in the years before closure; however. Charles. Drew University’s faculty, the practicing faculty completely disappeared. They were attracted to other hospitals that had. I don’t think anybody appreciated. Physicians in the underserved settings were more likely to endorse subthemes. Physicians in nonunderserved settings were more likely to describe no impact from hospital closure. Substantially more physicians who worked 1. By distance, similar numbers of physicians in local areas vs nonlocal areas described patient difficulty navigating. A majority of the physicians from. More than. half of the physicians we interviewed reported widespread and noteworthy effects of the hospital’s closure on their practices. The themes that emerged from these interviews describe a primary care workforce bearing the brunt of patient. Those physicians who practiced farther away were more. The personal and professional strain identified was related to the changes in workforce and teaching opportunities. Although useful for identifying exploratory themes, semistructured interviews. We worked to mitigate these. Our study was. shaped by our research team’s hypotheses and the CAB’s input a priori to data collection. Additionally, the physicians interviewed. Our CAB members were extremely. As the first wave of physicians referred others, our interviewed participants may have had similar views to. Additionally, the preconceptions and views of our participants may have been. For these reasons, the full range of issues after hospital closure may not have been. Because of these preconceptions, the experiences reported in Los Angeles County in the first year after closure. We realize that. some additional safety- net hospitals are located within the 1. Two additional public hospitals are within a 1. Los Angeles County, it can take. This particular issue with regular traffic congestion. Los Angeles’ travel patterns. In addition. our goal in this study was not to account for the confounding events that may have occurred elsewhere in the system; rather. Although our sample was nonrepresentative. Primary care physicians should be informed and consulted when a major. Physicians in both safety- net systems and non–safety- net systems. Although consistent themes about recommended next. They were concerned about addressing community perceptions, improving handoffs, and creating systematic assessments. In the first year after hospital closure. Safety- net hospitals will thus continue to serve a vital stop- gap role for. Medicaid, Medicare, and other targeted programs. Primary care clinicians in the. The physicians we interviewed described. It is important to anticipate. We would also like to thank Robin Ramey. MS, Trudy Singzon, MD, MPH, and Sharon L. Hayes for their assistance with data collection and preparation.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
November 2017
Categories |