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TRIAP: Is Triage by Healthcare Mini-teams Effective to Improve Efficiency in Primary Health Care? (TRIAP)

2015年8月4日 更新者：Roberto Gonzalez Santisteban、Basque Health Service

Background: With new challenges for healthcare, there is a clear consensus among experts on the need to introduce changes in the organization of care in health centres to address the problems of over-attendance, bureaucratization and other emerging issues that require growing amounts of attention. However, there has been insufficient research into possible models and the impact of their adoption.

The objective is to assess the feasibility and effectiveness of the TRIAP intervention, a new organizational model based on triage and healthcare mini-teams (two general practitioners/pediatricians, two nurses and one member of the administrative staff) compared to the current model, aiming to achieve a correct classification of the healthcare needs of the primary care population and direct them to the most suitable professional.

In addition, the implementation research objective is to identify the facilitators for and barriers to the implementation of the intervention in the context of primary care.

Methods/ design: This is a quasi-experimental controlled clinical trial to be performed in 14 healthcare mini-teams (7 intervention and 7 control groups) from 8 health centres in the Basque Healthcare Service (Osakidetza) Interior Health Region.

The results will be assessed using the data on morbidity-adjusted attendance of users to their family doctor, number of referral, addition of new activities to the portfolio of services, and patient perception and professional satisfaction. All the variables will be measured at baseline and at the end of the intervention, 24 months later.

Using covariance analysis models, the investigators will estimate the effect attributable to the intervention by analyzing differences in changes between the two groups, and calculating the 95% confidence interval, adjusting the comparisons for baseline values. The investigators will also adjust for potential confounding and effect-modifying variables.

Nominal groups will be held at the end of the intervention with the participation of all the agents involved in intervention centres to identify the facilitators for and barriers to the implementation of the intervention.

Discussion: There is a need to develop new forms of organization in primary care services to respond to new healthcare demands. To pursue this aim, changes have to be introduced in the organization of healthcare within health centres, redefining the roles of primary care professionals and refocusing their activity towards population health needs, seeking greater efficiency in health services.

調査の概要

状態

完了

条件

介入・治療

研究の種類

介入

入学 (実際)

10000

段階

  • フェーズ2

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究場所

  • スペイン
      • Vitoria、スペイン
        • Basque Healthcare Service

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

  • 子
  • 大人
  • 高齢者

健康ボランティアの受け入れ

いいえ

受講資格のある性別

全て

説明

Inclusion Criteria:

  • The study populations are patients of the seven mini-teams established, these professionals being responsible for the GP lists in the health centres of San Miguel in Basauri, Miraballes and Ondarroa, and the paediatric list in Etxebarri health centre. The control units are from the health centres of Basauri-Ariz, Arratia, Amorebieta and Bermeo, all located in the Interior Health Region.

Exclusion Criteria:

-

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：ヘルスサービス研究
  • 割り当て：非ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
実験的：TRIAP intervention
他の：TRIAP

The primary healthcare professionals organised in healthcare mini-teams, composed of 2 doctors, 2 nurses and 1 member of the administrative staff.

  1. Administrative staff:

    Following a flow chart, they will refer patients with mild self-limiting illnesses as well as consultations regarding chronic disorders in adults to the nurses. They will also perform administrative tasks such as the printing of prescriptions, sick leave reports and medical notes (justifying absence), etc.

  2. Nursing staff:

    They will carry out activities focused on health promotion, self-management and de-medicalisation during visits from patients with mild self-limiting illnesses as well as appointments for chronic diseases in adults.

  3. GP:

They will develop the new portfolio of services: health promotion, joint review of patient medical records by doctors and nurses to improve the management of certain groups of patients, and organization of minor surgery services, etc.
介入なし：Usual care
Usual care: Patients in the control group will be treated according to Osakidetza recommendations.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Patients attendance
時間枠：Baseline and at 24 months

Number of visits of the patients to their GP and paediatricians in accordance to the Adjusted Clinical Groups [ACG] Case-Mix System.

The patients will be classified using the ACG system, on the basis of their age, sex and ICD-9-CM codes of health problems diagnosed over a year in visits to their GP/paediatrician. The ACG case-mix system was designed by researchers at Johns Hopkins University, originally for care on an outpatient basis, and classifies the population into around 100 self-excluding categories.

Regardless of the number of contacts with the healthcare services, each person is classified every year into a single ACG depending on their age, sex, and combination of diagnoses they were assigned over the previous 12 months. For this study, we will use the ACG Assignment Software version 7.00.

All the tasks performed will be recorded in the Osabide computer system of the Basque Health Service.
Baseline and at 24 months

二次結果の測定

結果測定
メジャーの説明
時間枠
Patients referral: number of patient referrals by GPs and paediatricians in accordance to the Adjusted Clinical Groups [ACG] Case-Mix System.
時間枠：Baseline and at 24 months
Baseline and at 24 months
New activities added to the current portfolio of services
時間枠：Baseline and at 24 months
Number of programmed activities of health promotion, joint review of medical records by the doctors and nurses to improve the management of certain groups of patients, minor surgery services in PC, activities for achieving a comprehensive approach to managing non-surgical osteomuscular disorders and the use of ultrasound scans.
Baseline and at 24 months
Patient satisfaction
時間枠：Baseline and at 24 months
Measured using the Primary Care Assessment Tool (PCAT) Pasarín MI et al. Evaluation of primary care: The "Primary Care Assessment Tools - Facility version" for the Spanish health system. Gac Sanit. 2013 Jan-Feb;27(1):12-8.
Baseline and at 24 months
Satisfaction of health professionals
時間枠：Baseline and at 24 months

In terms of professional quality of life measured using the Professional Quality of Life questionnaire (PQL-35).

Cabezas, C. La calidad de vida de los profesionales. FMC. 2000;7 (Supl 7):53-68.
Baseline and at 24 months

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Basque Health Service

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始

2012年9月1日

一次修了 (実際)

2014年10月1日

研究の完了 (実際)

2014年10月1日

試験登録日

最初に提出

2014年8月6日

QC基準を満たした最初の提出物

2014年8月7日

最初の投稿 (見積もり)

2014年8月8日

学習記録の更新

投稿された最後の更新 (見積もり)

2015年8月6日

QC基準を満たした最後の更新が送信されました

2015年8月4日

最終確認日

2015年8月1日

詳しくは

本研究に関する用語

その他の研究ID番号

  • TRIAP
  • 2011111131 (その他の助成金/資金番号：Basque Health Goverment)

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