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The role of slack resources and influenza vaccinations for primary care practices

Mohr DC, Benzer JK, Young GJ, Nealon Seibert M, White RA. The role of slack resources and influenza vaccinations for primary care practices. Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jul 27; Boston, MA.

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Background: The administration of an annual influenza (flu) vaccination has been advocated as a best practice in outpatient care for older adults and its use is associated with lower lower risks of pneumonia, hospitalization and death for patients. Despite the benefits, not all eligible patients receive vaccinations. Changes in organizational structure (e.g., job redesign, procedures, infrastructure) has noted as an effective way to improve influenza vaccination rates. Because vaccinations occur during a few months during the year, higher resource demand is placed on practices during this time. This study investigates the effect of organizational slack resources, the extra pool or "cushion" of resources, on the likelihood of a patient receiving a vaccination. Study design: The study is a multi-level analysis using patient-level and practice-level data. The dependent variable for the study is a dichotomous variable to indicate whether an eligible patient received an influenza vaccine. Slack resources variables consisted of the ratio of observed panel size to capacity of the panel size for the primary care practice (where 100% indicates balance and higher values indicate greater demand on practice). Botha linear and a curvilinear term were used. A dichotomous variable was created based on whether the number of support staff per provider ratio exceeded 2.5. The model controlled for a number of geographical characteristics (square mile coverage, urbanization, and census region), patient demand (appointments per month, and ratio of new to established patients), and practice size characteristics (teaching hospital affiliation, hospital or community-based practice, and number of provider FTE). Population studied: Over 14,000 patients were included over a five-month time period in 2007. A total of 614 primary care practices were included. The context was the Veterans Health Administration in the United States. Principal Findings: The model provided support for the role of slack resources. We found a positive effect for the linear panel size ratio variable and a negative effect for the curvilinear panel size ratio variable. We found additional support staff was associated with a greater likelihood of vaccination. We found other factors positively associated with likelihood of vaccination to include patient age, northeast geographic region, and teaching affiliation. Discussion: Findings indicate that having a panel size ratio that is too high can decrease the likelihood of vaccinations being performed. Having additional support staff may be another way to organize the practice during busy times to cope with the demand for the service. Findings highlight the importance of monitoring and aligning panel size and support staff along with patient demand to find a balance. Implication for Policy: In terms of managing the workforce supply, results indicate that for vaccination rates, the panel size ratio should be closely monitored. Hiring additional support staff may help to alleviate the workload for growing practices or practices that have lost provider staff recently. The extra support staff can cost more and require additional space, but they may be able to improve quality adherence tasks and activities.

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