Outpatient provider staffing ratios: Binary recursive models associated with quality, access, and satisfaction.

Abstract

Veterans Health Administration (VHA) continues to expand the mental health (MH) workforce to meet increasing demand for services. In the present study, longitudinal unbiased recursive partitioning models (conditional inference trees) were created to identify optimal cutoffs for outpatient staffing ratios associated with success on VHA's measures of quality, access, and satisfaction. Quarterly Staff-to-Patient Ratios (SPRs), defined as the number of full-time equivalent providers per 1,000 veterans receiving outpatient mental health care, were calculated for 12 quarters from fiscal years 2016-2018. Associations between VHA metrics associated with quality, access, and satisfaction were evaluated in relation to the overall outpatient SPR. The root node identified an overall outpatient SPR of 7.39 as the split for optimal MH performance. Root nodes associated with metrics addressing population coverage, continuity of care, and experience of care identified SPRs of 7.87, 6.81, and 7.42, respectively. In all analyses, the lowest SPRs were associated with the lowest performance on VHA MH metrics, while the highest SPRs were associated with the highest performance. Analyses support VHA's current recommended minimum outpatient SPR of 7.72 as a reasonable target to provide high-quality care, access, and satisfaction. (PsycInfo Database Record (c) 2021 APA, all rights reserved).