Testing new ways to schedule appointments at community health centers to help patients access care / Amy Miller.

Format:

Book

Author/Creator:

Miller, Amy, author.

Language:

English

Subjects (All):

Medical care.

Physical Description:

1 online resource (93 pages)

Place of Publication:

Washington (DC) : Patient-Centered Outcomes Research Institute (PCORI), 2020.

Summary:

BACKGROUND: The National Academy of Medicine defines access to health care as "the timely use of personal health services to achieve the best health outcomes." Evidence shows the impact of limited access to be a significant burden. Enhanced access and continuity are also core components of patient-centered care. Interventions to improve access to care do not always achieve positive results. This project aimed to identify and implement systems strategies for improving access to health care for underserved populations. OBJECTIVES: There were 3 aims: (1) Identify and prioritize patient-centered strategies to reduce accommodation barriers to care; (2) develop a computer simulation model of community health centers to model and test the feasibility and impact of the proposed strategies; and (3) coach clinics to implement multicomponent strategies to enhance access to and continuity of care for all patients. METHODS: To identify barriers and improve access to health care, our team worked closely with 7 community health clinic (CHC) systems across Indiana. We interviewed different stakeholders (patients, staff, and care providers), and observed and modeled workflow. Using a modified Delphi panel, the stakeholders identified, discussed, amended, and ranked solutions to improve access. In order to support the analyses and benchmarking, we developed a multidimensional community data warehouse (CDW) of the 7 CHCs and their electronic medical record (EMR) systems, focusing on scheduling and outcomes data. Using the CDW, we performed simulation modeling of current supply, demand, and resources, to identify and test different scheduling and policy options to improve access to care. We then selected 3 CHC systems and coached them on designing and implementing the most promising strategies. RESULTS: We interviewed 96 stakeholders and used a modified Delphi panel of 40 stakeholders. System redesign simulation methods helped us identify and prioritize the most feasible and impactful patient-centered, system-level approaches to reduce accommodation barriers to care. Our interventions included (1) expanding and optimizing open access scheduling with customized strategies for each CHC to increase same-day appointments and reduce the missed appointment rate, (2) using role-specific data analytical dashboards to foster continued engagement and progress, and (3) fostering a customer service and accountability culture. We observed modest improvements in appointment scheduling at 2 of the 3 CHCs after implementing the intervention. CONCLUSIONS: Patient-centered systems redesign methods, including stakeholder interviews, a modified Delphi panel, and simulation modeling, helped identify, prioritize, and tailor CHC-specified strategies. We applied simulation modeling approaches to reduce barriers to access to care in Indiana CHCs through the expansion of open access scheduling, encouraging a culture of customer service, and provision of feedback through an interactive dashboard of performance metrics. These methods hold promise for redesigning other CHCs. LIMITATIONS: Our participating clinics were conducting their normal business during our 3-year study, and as such had many competing initiatives, experienced turnover in staff and administrators, underwent changes in EMR vendors and systems, and navigated modifications in health insurance coverage in Indiana during the study period--all of which might have impacted our findings. Another limitation was that we selected the clinics for intervention based on readiness to implement operational and policy changes, which might have introduced bias. Finally, the study follow-up period was too short to observe expected effects from the culture change intervention.

Notes:

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