The Use of Enhanced Appointment Access Strategies by Medical Practices

Rodríguez, Hector P.; Knox, Margae; Hurley, Vanessa B; Rittenhouse, Diane R.; Shortell, Stephen M.

doi:10.1097/mlr.0000000000000527

Cited by 7 publications

(7 citation statements)

References 34 publications

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“…Although the challenges of scheduling doctor visits have not been as widely documented in the literature, previous studies suggest that the lack of timely appointments, prolonged waiting periods, and the general difficulties involved in navigating follow-up care are the most commonly cited barriers in scheduling appointments for medical care. 25,44,48–50 The degree to which these factors played a role in the findings is unclear without additional qualitative data on the explicit reasons attributable to difficulties in making appointments. Nevertheless, our analysis adjusted for a broad range of factors—e.g., socioeconomic background, psychosocial resources, utilization history, and health status—and the results remained largely unchanged.…”

Section: Discussionmentioning

confidence: 99%

Access to routine care and risks for 30-day readmission in patients with cardiovascular disease

Dupre

Granger

et al. 2018

American Heart Journal

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Section: Discussionmentioning

confidence: 99%

Access to routine care and risks for 30-day readmission in patients with cardiovascular disease

Dupre

Granger

et al. 2018

American Heart Journal

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“…The overall PCMH model has potential to improve access, primarily through increased capacity. 19,20 The PCMH requires reorganizing care from the traditional, physiciancentric model of care to an interdisciplinary design. 21 This can potentially increase capacity by redistributing the PCP workload to other members of the team.…”

Section: Discussionmentioning

confidence: 99%

Components of the Patient-Centered Medical Home Associated with Perceived Access to Primary Care

et al. 2020

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BACKGROUND: Following implementation of the patientcentered medical home (PCMH) within the Department of Veterans Affairs (VA), access to primary care improved. However, understanding of how this occurred is lacking. OBJECTIVE: To examine the association between organizational aspects of the PCMH model and access-related initiatives with patient perception of access to urgent, same-day, and routine care within the VA. DESIGN: Cross-sectional PARTICIPANTS: Veterans who responded to the annual Survey of Healthcare Experiences of Patients in 2016 (N = 241,122 patients) and primary staff who responded to VA National Primary Care Provider and Staff Survey (N = 4815 staff). MAIN MEASURES: Three outcomes of perception of access: percentage of patients responding in the highest category for same-day care (waiting ≤ 1 day), urgent care (always receiving care when needed), and routine care (always receiving checkups when desired). Predictors were staff-level report of access-related initiatives and organizational factors in the clinic. We used generalized estimating equations to model associations, adjusting for characteristics of patients and their respective clinics. KEY RESULTS: Access was significantly better in clinics where staff reviewed performance reports (+ 0.9% in the highest perception of access for urgent care, P < 0.01; + 1.2% for routine care, P < 0.001), leadership was supportive of the PCMH (+ 1.6% for urgent care, P < 0.01), and initiatives to improve access included open access (+ 0.8% to + 1.7% across all outcomes, P < 0.01) and telehealth visits (+ 1.2% to + 1.4%, P < 0.001). Perceived access was worse in clinics with moderate staff burnout (− 1.1% to − 1.4%, P < 0.001), primary care provider turnover during the past year (− 1.0% to − 1.6%, P < 0.001), or medical support assistant turnover in the past year (− 0.9% to − 1.4%, P < 0.001). CONCLUSIONS: Perception of access was strongly associated with identifiable organizational factors and accessrelated initiatives within VA primary care clinics that could be adopted by other health systems.

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“…Enhanced access to care: Teamwork is associated with enhanced access to care and has been consistently shown to be important in patient satisfaction. 18 Good teamwork in a PCMH is critical to sustaining patient-physician/practice relationships and ensuring continuity and reduced unnecessary utilization. 22,23 The persistence of and the improvement in team functioning at the PCMH despite reduced practice supports is encouraging and, supports the continued efforts at practice transformation.…”

Section: Discussionmentioning

confidence: 99%

“…Teamwork is critical to patient centered care delivery to enhance access, care coordination, patient satisfaction, enhanced quality, and ultimately lead to cost reduction. 16-18 Active participation in learning collaborative, evidence-based training, HIT supports, and quality improvement may be sufficient to maintain transformation and teamwork in high functioning practices. 19-21 Teamwork measured objectively using the TPQ has provided critical evidence that team functioning continues to improve in PCMHs participating in collaborative learning in our program despite the reduction in coaching practice supports.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of PCMH Model Adoption on Teamwork and Impact on Patient Access and Safety

Khanna

Shaya

Gaitonde

et al. 2016

J Prim Care Community Health

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Purpose: Each of the participating patient-centered medical home (PCMH) received coaching and participated in learning collaborative for improving teamwork. The objective of the study was to assess the impact of trainings on patient-centered teamwork. Methods: The Teamwork Perception Questionnaire (TPQ) was administered once in spring 2014 and then in fall 2015. The TPQ consists of 35 questions across 5 domains: mutual support, situation monitoring, communication, team structure, and leadership. Based on our objective we compared the frequencies of strongly agree/agree by domain. The difference was tested using chi-square test. We compared the scores on each domain (strongly agree/agree = 1; maximum score = 7) via Wilcoxon rank sum test. Results: The response rate for this survey was n = 29 (80.6%) in spring 2014, and n = 31 (86.1%) in fall 2015. We found that the practice members significantly (P < .05) strongly agreed/agreed more in fall 2015 than spring 2014 for characteristics—“staff relay relevant information in a timely manner” (64.5% vs 83.9%) and “staff follow a standardized method of sharing information when handing off patients” (67.7% vs 90.3%) under communication domain and for characteristic—“staff within my practice share information that enables timely decision making” (74.2% vs 90.3%). However, there was no statistical significant difference observed in the scores for the overall TPQ at the 2 time points. Conclusion: Despite the statistical insignificance, the observations in PCMHs across the spectrum of practices participating in the Maryland Multi-Payer Program demonstrated enhanced teamwork specifically in communication and in leadership. This we believe will continue to result in enhanced patient access to care and safety.

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The Use of Enhanced Appointment Access Strategies by Medical Practices

Abstract: Open access scheduling may be most effectively implemented by practices with robust PCMH capabilities. External incentives appear to influence practice adoption of after-hours care. Expanding open access scheduling and after-hours care will require distinct policies and supports.

Cited by 7 publications

References 34 publications

Access to routine care and risks for 30-day readmission in patients with cardiovascular disease

Access to routine care and risks for 30-day readmission in patients with cardiovascular disease

Components of the Patient-Centered Medical Home Associated with Perceived Access to Primary Care

Evaluation of PCMH Model Adoption on Teamwork and Impact on Patient Access and Safety

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