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Patient Flow pp 173-196 | Cite as

Managing Patient Appointments in Primary Care

  • Sergei Savin
Chapter
Part of the International Series in Operations Research & Management Science book series (ISOR, volume 206)

Abstract

In recent years, many US health care establishments have found themselves under increasing pressure to improve the cost-effectiveness of their operations in the face of tight competition, while maintaining high standards of care. Finding the best trade-off between these competing objectives is not an easy task, since the efforts to keep costs under control often result in overutilization of existing resources and, as a consequence, increased patient delays. The Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century identifies “timeliness” as one of six goals that should drive the redesign of the health care delivery system in the coming years. For many patients, primary care is one of the most important settings for their contact with the health care system. In this setting, an appointment mechanism directly determines “timeliness” of received care. In this chapter we introduce a simple model that describes the evolution of appointment backlogs in a primary office setting and describe how expected value and the variance of the daily demand for appointments influences backlog buildup. We also discuss the popular practice of advanced access, a newly proposed approach for reducing and eliminating appointment delays. In particular, we develop a set of guidelines that any primary care office should use in determining the patient panel size to support the advanced access approach. Our guidelines are illustrated through a set of examples based on the demand and supply data taken from the surveys of the American Academy of Family Practice as well as 2002 National Ambulatory Medical Care Survey.

Keywords

Access to care Appointment scheduling Advanced access Optimal patient panel size 

References

  1. Batal, H., Tench, J., McMillan, S., Adams, J., & Mehler, P. S. (2001). Predicting patient visits to an urgent care clinic using calendar variables. Academic Emergency Medicine, 8(1), 48–53.CrossRefGoogle Scholar
  2. Beck, J., Scott, J., Williams, P., Robertson, B., Jackson, P., Gade, G., et al. (1997). A randomized trial of group outpatient visits for chronically ill older HMO members: The cooperative health care clinic. Journal of American Geriatric Society, 45(5), 543–549.Google Scholar
  3. Cayirli, T., & Veral, E. (2003). Outpatient scheduling in health care: A review of literature. Production and Operations Management, 12(4), 519–549.CrossRefGoogle Scholar
  4. Declaration of the International Conference on Primary Health Care. (1978). Retrieved from http://www.euro.who.int/AboutWHO/Policv/20010827-1.
  5. Forjuoh, S. N., Averitt, W. M., Cauthen, D. B., Symm, B., & Mitchell, M. (2001). Open-access appointment scheduling in family practice: Comparison of a demand prediction grid with actual appointments. Journal of the American Board of Family Practice, 14(4), 259–265.Google Scholar
  6. Gordon, P., & Chin, M. (2004). Achieving a new standard in primary care for low-income populations: Case study 2: Advanced access learning. The Commonwealth Fund Report, New York, NY.Google Scholar
  7. Grandinetti, D. (2000). You mean I can see a doctor today? Medical Economics, 77(6):102-4, 109, 113-4.Google Scholar
  8. Houck, S. (2004). What works: effective tools and case studies to improve clinical office practice (p. 90). Boulder, CO: HealthPress Publishing.Google Scholar
  9. Houck, S., Kilo, C., & Scott, J. C. (2003). Improving patient care. Group visits 101. Family Practice Management, 10(5), 66–68.Google Scholar
  10. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century (p. 51). Washington, DC: National Academy Press.Google Scholar
  11. Masley, S., Sokoloff, J., & Hawes, C. (2000). Planning group visits for high-risk patients. Family Practice Management, 7(6), 33–37.Google Scholar
  12. Murray, M., & Berwick, D. M. (2003). Advance access: reducing waiting and delays in primary care. JAMA, 289(8), 1035–1039.CrossRefGoogle Scholar
  13. Murray, M., & Tantau, C. (2000). Same-day appointments: Exploding the access paradigm. Family Practice Management, 7–8, 45–50.Google Scholar
  14. Nolan, T. W., Schall, M. W., Berwick, D. M., & Roessner, J. (1996). Reducing delays and waiting times throughout the healthcare system. Cambridge, MA: Institute for Healthcare Improvement.Google Scholar
  15. O’Hare, C. D., & Corlett, J. (2004). The outcomes of open-access scheduling. Family Practice Management, 11(2), 35–38.Google Scholar
  16. Oldham, J. (2001). Advanced access in primary care. National Primary Care Development Team. Retrieved from http://www.npdt.org/AccesstoPrimaryCare/advancedaccess.pdf.
  17. Oldham, J. (2002). Telephone use in primary care. British Medical Journal, 325(7363), 547.CrossRefGoogle Scholar
  18. Starfield, B. (1991). Primary care and health. A cross-national comparison. JAMA, 266, 2268–2271.CrossRefGoogle Scholar
  19. Wick, A., & Koller, M. T. (2005). Views of patients and physicians on follow-up visits. Swiss Medical Weekly, 135, 139–144.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Graduate School of BusinessColumbia UniversityNew YorkUSA

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