Abstract
ObjectiveTo identify priorities for improving healthcare organization management of patient access to primary care based on prior evidence and a stakeholder panel.BackgroundStudies on healthcare access show its importance for ensuring population health. Few studies show how healthcare organizations can improve access.MethodsWe conducted a modified Delphi stakeholder panel anchored by a systematic review. Panelists (N = 20) represented diverse stakeholder groups including patients, providers, policy makers, purchasers, and payers of healthcare services, predominantly from the Veterans Health Administration. A pre-panel survey addressed over 80 aspects of healthcare organization management of access, including defining access management. Panelists discussed survey-based ratings during a 2-day in-person meeting and re-voted afterward. A second panel process focused on each final priority and developed recommendations and suggestions for implementation.ResultsThe panel achieved consensus on definitions of optimal access and access management on eight urgent and important priorities for guiding access management improvement, and on 1–3 recommendations per priority. Each recommendation is supported by referenced, panel-approved suggestions for implementation. Priorities address two organizational structure targets (interdisciplinary primary care site leadership; clearly identified group practice management structure); four process improvements (patient telephone access management; contingency staffing; nurse management of demand through care coordination; proactive demand management by optimizing provider visit schedules), and two outcomes (quality of patients’ experiences of access; provider and staff morale). Recommendations and suggestions for implementation, including literature references, are summarized in a panelist-approved, ready-to-use tool.ConclusionsA stakeholder panel informed by a pre-panel systematic review identified eight action-oriented priorities for improving access and recommendations for implementing each priority. The resulting tool is suitable for guiding the VA and other integrated healthcare delivery organizations in assessing and initiating improvements in access management, and for supporting continued research.
Highlights
Providing access to healthcare is a fundamental primary care function and a necessary prerequisite for judging care quality.[1]
We initiated a systematic review of research evidence on diverse access management interventions[5] and a qualitative study of the Veterans Health Administration (VHA) access manager initiative[6] as part of a 2-year-long project capped by the modified Delphi panel process reported here
Panelists were primarily associated with VHA, but included one from Canada, one from Kaiser Permanente, and a senior adviser to the US Government Centers for Medicare & Medicaid Services who is affiliated with the VHA
Summary
Providing access to healthcare is a fundamental primary care function and a necessary prerequisite for judging care quality.[1] Yet, translation of the substantial research on the importance and determinants of access into sustainable access improvement in healthcare delivery organizations has lagged. Expert panels can provide a basis for moving forward when existing research evidence is insufficient.[2,3,4] We initiated a systematic review of research evidence on diverse access management interventions[5] and a qualitative study of the Veterans Health Administration (VHA) access manager initiative[6] as part of a 2-year-long project capped by the modified Delphi panel process reported here. Our goal was to provide evidence-informed guidance on top priorities for Rubenstein et al.: Improving Primary Care Access Management
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