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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1058 — Characterizing Primary Care Provider (PCP) Activity in Routine Practice

Gutierrez JC, PVAMC; Marcus S, PVAMC; Terwiesch C, Wharton; Werner R, PVAMC;

Objectives:
Increasing time and staffing pressures in primary care (PC) have lead many to believe provider roles should be redefined and activities should be redistributed among PC team members to better match provider actions with licensed abilities, thus increasing productivity. This has been particularly important under medical-home models, such as the Patient Aligned Care Teams (PACT) at VA, where an important component is to continually assess and improve work roles and environment for providers. As a first step, it is essential to observe how providers spend their time to identify opportunities for PC teams to work more efficiently and effectively.

Methods:
We randomly selected full-time PCPs at the Philadelphia VAMC and one CBOC (Fort Dix). Consenting providers were video-recorded during their normal clinic hours, with patient consent. The research team reviewed videotapes to identify discrete tasks performed by providers during their encounters and then quantified the number and duration of each task.

Results:
We recorded and rated 31 patient encounters with 9 PCPs. We identified 13 specific tasks that providers typically perform, accounting for 99.9% of provider time. Average visit duration was 24 minutes. The majority of that time was spent discussing existing conditions (6:07); prescribing, refilling and adjusting medications (6:01); examining the patient (3:09); writing notes (1:59); and discussing new treatments or conditions (1:36).

Implications:
Our findings provide insight into how VA PCPs currently spend their time to ensure that providers are practicing at the top of their license, and identify tasks that might be amenable to reassignment under new staffing models, such as PACT.

Impacts:
Our classification system is the first step toward identifying tasks that (1) only a PCP can carry out in the presence of the patient; (2) only a PCP can carry out, but could be done remotely; (3) could be performed, remotely or in person, by a non-provider; or (4) could be eliminated entirely. This tool can potentially be used for evaluating the PACT teams, as well as highlighting areas for potential interventions to better serve Veterans.


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