Appointments For New Patients Research Articles

EP06.01-015 Will Virtual Care Stand the Test of Time; One Site’s Perspective on the Continuity of Virtual Care Post-Pandemic

EP06.01-015 Will Virtual Care Stand the Test of Time; One Site’s Perspective on the Continuity of Virtual Care Post-Pandemic

The Impact of Remote Urology Outpatient Clinics during the COVID-19 Pandemic

Introduction: The coronavirus (COVID-19) pandemic of 2020 had a major impact on NHS services. From the 23rd of March 2020, the Urology Department in Basingstoke initiated telephone-led consultation clinics instead of face-to-face outpatient appointments, in accordance with U.K. guidance. Objectives: To evaluate patient experience and satisfaction following the introduction of remote (telephone) consultations during the COVID-19 pandemic. Patients and methods: The first 200 remote patient appointments between the 30th of March 2020 and the 16th of April 2020 were sent a postal questionnaire (19 questions relating to their experience and level of satisfaction with the interaction). Telephone consultations were conducted by 6 consultants, 3 registrars, and 2 specialist nurses. The patients were not prewarned to expect a questionnaire after the remote appointment. The associated cost saving resulting from a switch from face-to-face appointments to remote telephone appointments was also calculated. Results: 100 out of the 200 patients responded within 1 month (response rate 50%). A total of 44% of the patients were new referrals, while 56% were follow-ups. Overall, the feedback was positive regarding the telephone consultation, with 88% rating the care received as excellent or very good. In addition, 90% would recommend a telephone consultation to family and friends. However, 35% would prefer in the future to have another telephone consultation rather than face-to-face consultation, with 46% preferring a face-to-face appointment in the future and 19% unsure. For new patients, the proportion wishing to have a face-to-face appointment, in the end, was unsurprisingly higher than it was for those undergoing a follow-up (39% vs. 7 %). In these 2 weeks, the cost reduction to the NHS from shifting from face-to-face consultation to telephone consultation was estimated to be £6500. Conclusions: Telephone urology clinics are a satisfactory alternative to face-to-face appointments for many of our patients now and beyond the COVID-19 pandemic. They are efficient, cost-effective, and feasible to undertake urological consultation and can be implemented successfully in selected patients. The feedback from this questionnaire would suggest that priority should be given to face-to-face appointments for new patients and for complex follow-up appointments. Telephone follow-up appointments, however, are a good approach for the majority of patients.

A Burnout's Rehab.

On Being a Doctor20 August 2019A Burnout's RehabDiana Pi, MDDiana Pi, MDWestlake, Ohio (D.P.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2911 Audio Reading - “A Burnout's Rehab” Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads “A Burnout's Rehab” by Diana Pi, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For 20 years, I was a generalist at a hospital-based outpatient practice. After following us for weeks, a team of consultants sat us down and unloaded ways to improve our efficiency. My hardest change: 20-minute appointments for new patients. Months later, I hung up my white coat and walked out hugging a plastic crate containing everything I cared to keep from my professional life—two diplomas, a board certificate, two flash drives, a stethoscope, a backup stethoscope, an otoscope, and a no-name vine that had survived on indirect sunlight in my office for decades.I was 49. And burned out.My ... Author, Article, and Disclosure InformationAffiliations: Westlake, Ohio (D.P.)Corresponding Author: Diana Pi, MD, 25739 Briarwood Court, Westlake, OH 44145; e-mail, diana.pi.[email protected]com. PreviousarticleNextarticle Advertisement Audio Reading - “A Burnout's Rehab” Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads “A Burnout's Rehab” by Diana Pi, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 20 August 2019Volume 171, Issue 4Page: 295-296KeywordsBlindnessChartsNursesRabbitsReasoningSmellStomachSweatThoraxTraumatic brain injury ePublished: 20 August 2019 Issue Published: 20 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Staff perspectives of a model of access and triage for reducing waiting time in ambulatory services: a qualitative study

BackgroundSpecific Timely Appointments for Triage (STAT) is an intervention designed to reduce waiting time in community outpatient health services, shown to be effective in a large stepped wedge cluster randomised controlled trial. STAT combines initial strategies to reduce existing wait lists with creation of a specific number of protected appointments for new patients based on demand. It offers an alternative to the more traditional methods of demand management for these services using waiting lists with triage systems. This study aimed to explore perceptions of clinicians and administrative staff involved in implementing the model.MethodSemi-structured interviews with 20 staff members who experienced the change to STAT were conducted by an independent interviewer. All eight sites involved in the original trial and all professional disciplines were represented in the sample. Data were coded and analysed thematically.ResultsParticipants agreed that shorter waiting time for patients was the main advantage of the STAT model, and that ongoing management of caseloads was challenging. However, there was variation in the overall weight placed on these factors, and therefore the participants’ preference for the new or previous model of care. Perceptions of whether the advantages outweighed the disadvantages were influenced by five sub-themes: staff perception of how much waiting matters to the patient, prior exposure to the management of waiting list, caseload complexity, approach and attitude to the implementation of STAT and organisational factors.ConclusionsThe STAT model has clear benefits but also presents challenges for staff members. The findings of this study suggest that careful preparation and management of change and active planning for known fluctuations in supply and demand are likely to help to mitigate sources of stress and improve the likelihood of successful implementation of the STAT model for improving waiting times for patients referred to community outpatient services.

Patient satisfaction and physician productivity in shared medical appointments for vitiligo

The shared medical appointment (SMA) allows patients with a similar diagnosis to be simultaneously cared for and educated by 1 provider, which has had success in dermatology and other fields of specialty. The SMA provides a potential solution to improve patient access to dermatologists. The purpose of this study was to implement the SMA for patients with vitiligo and compare it to traditional appointments with regard to patient satisfaction, time to appointment, number of new patients seen per month, and generated revenue. A vitiligo SMA was implemented, and a 12-question survey was used to assess satisfaction in both SMA and traditional appointment settings. Satisfaction, revenue, and appointment logistic data for SMAs were compared with those for traditional appointments for new patients. Patients were highly satisfied with both SMAs and traditional appointments (P>.05). Time to appointment was faster for the SMA, and significantly more new patients were seen monthly with the SMA (P=.009). Limitations include small sample size, inability to correlate responder characteristics with survey responses, potential response bias, and selection bias due to absence of randomization. SMAs were successful in a vitiligo clinic for both patient and provider. The SMA is a solution to improve access to dermatologists without compromising patient benefit, experience, orsatisfaction.

Evaluating transformation with available resources: The influence of APEX on depression screening.

The University of Colorado developed and piloted a team-based primary care delivery model called ambulatory process excellence (APEX) in a family medicine residency in 2015. We evaluated its impact on depression screening using found data and tools readily available to practice-based evaluators. The APEX model calls for 5 medical assistants (MAs) supporting 2 providers. MAs have dedicated time to provide delegated care, including depression screening with 2 versions of the Patient Health Questionnaire: PHQ-2 and PHQ-9. Using an interrupted time-series-with-control design, we created longitudinal profiles of the pilot and a control practice using statistical process control charts. We obtained data from preexisting dashboards derived from the electronic medical record. Outcomes included PHQ-2 screening rates, patients screening positive, and the proportion of them completing a PHQ-9. Covariates included monthly visits and new-patient appointments. Using Microsoft Excel, we transformed all data into modified z scores, plotted them on a multivariate control chart for each practice, and assessed them for evidence of special cause variation. Key informants provided information about potentially confounding concurrent events. Compared with baseline, the intervention practice significantly increased primary care medical visits and new-patient appointments, increased positive PHQ-2 patients, and improved PHQ-9 completion. High screening rates remained stable. In the control practice, new-patient appointments increased and PHQ2 screening improved. APEX may contribute to better depression-screening processes. We have provided a detailed description of a real-world, practice-based, quasi-experimental evaluation model using common spreadsheet software (Microsoft Excel) to transform and analyze found data with multivariate statistical process-control charts. (PsycINFO Database Record

Access to Primary Care Appointments Following 2014 Insurance Expansions.

The Patient Protection and Affordable Care Act (ACA) expanded coverage to roughly 12 million individuals by mid-2014 and 20 million by 2016, raising concern about the capacity of the primary care system to absorb these individuals. We set out to determine how justified the concern was. We used an audit design in which simulated patients called primary care practices seeking new-patient appointments in 10 diverse states (Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas) from November 2012 through March 2013 and from May 2014 through July 2014, before and after the major ACA insurance expansions. Callers were randomly assigned to scripts specifying either private or Medicaid insurance and called only offices identified as "in network" for each plan. We completed 5,385 private insurance and 4,352 Medicaid calls in 2012-2013 and 2,424 private insurance and 2,474 Medicaid calls in 2014. Overall appointment rates for private insurance remained stable from 2012 (84.7%) to 2014 (85.8%) with Massachusetts and Pennsylvania experiencing significant increases. Overall, Medicaid appointment rates increased 9.7 percentage points (57.9% to 67.6%) with substantial variation by state. Across all callers, median wait times for those obtaining an appointment were 7 days in 2012 and 5 days in 2014, but the difference was not statistically significant. Contrary to widespread concern, we find no evidence that the millions of individuals newly insured through the ACA decreased new-patient appointment availability across 10 states as shown by stable wait times and appointment rates for private insurance as of mid-2014.

Effects of Rescheduling on Patient No-Show Behavior in Outpatient Clinics

We study patients' no-show behavior in an outpatient appointment system for both new and follow-up patients, and explicitly consider rescheduling. Previous studies have either focused on appointments for new patients or treated rescheduled appointments as new ones. Findings from most of these studies reveal that no-show probability increases significantly with waiting time. We offer a more nuanced understanding of this costly phenomenon. Using clinical data, we demonstrate that the effect of waiting time on no-show behavior is largely weakened if the appointment was rescheduled. No-show behavior is also significantly affected by the rescheduling process, and patients of different types respond to rescheduling in notably different ways. For follow-up patients, no-show probability decreases when the appointment was rescheduled at the patient's request and increases when it was rescheduled by the clinic. New patients, in contrast, care more about whether the rescheduled appointment is sooner or later than the original appointment, rather than who initiated rescheduling. To the extent that rescheduling has a significant impact on no-show behavior, our findings offer managers a deeper understanding of patient no-show behavior and could be helpful in formulating effective policies to improve attendance rates.

The City of Hope (COH) performance excellence program (PEP): A physician incentive program to improve health care performance (HCP) in an academic medical center.

e17556 Background: The Affordable Care Act (ACA) introduced a pay for performance model focused on: safety, timeliness, effectiveness, efficiency, patient-centered, equitable care. COH is an NCI sponsored Comprehensive Cancer Center, focused on cancer care. Methods: In 2011, a physician led team with representation from finance, QRRM, nursing and legal identified 13 quality measures (QM) where opportunities for improvement (OFI) existed. Selection criteria included measurability, importance, applicability to ACA, physician impact, return on investment and national importance. The QM include HCAHPS score, Healthcare Associated Infection rate (HAI), quantity of blood products internally produced (BP), coder response rate (RR), use of sepsis bundle orders, time to new patient appointments (NPA), OR 1st case on-time starts, timeliness of adjuvant therapy for breast/colon cancer patients, SCIP composite score and use of VTE prophylaxis orders. HCP for the first 4 QM was assessed based upon institutional performance; 6 QM were assessed upon departmental performance. There were 3 build measures (BM): creating a system to obtain advanced directives (AD) on all new patients, creating a system for effective communication with referring physicians and 4 departmental BM based on best practices. Results: PEP performance was assessed between 5/1/12-12/31/12. 174 physicians in 11 departments were eligible for a $2.05 million incentive pool. QM were evaluated using a tiered bonus structure. Significant improvements were seen in HAI, BP production, SCIP, OR starts and timely adjuvant therapy. There were improvements in the use of VTE orders, but aggregate performance fell below payment threshold. The build measure for AD was completed. Conclusions: (1) PEP is an effective tool for physician engagement in an academic medical center. (2) PEP enhanced alignment between the medical group, hospital, nursing and administration. (3) PEP was effective in improving HCP in less than one year from its inception. [Table: see text]

A New Model to Decrease Time-to-Appointment Wait for Gastroenterology Evaluation

To describe the implementation and evaluation of a quality improvement intervention to increase new-patient access and decrease time-to-appointment wait for gastroenterology care. We used a new model of care for gastroenterology evaluation. For specified clinical complaints, we offered new-patient appointments that were scheduled with a general pediatrician as an alternative to a subspecialist. A nurse navigator assisted in triaging patients. We analyzed all patient encounters over an 8-month period. To verify decreased time-to-appointment wait, mystery shoppers made semimonthly calls to centralized scheduling. We surveyed parents/families after visits with the pediatrician or subspecialists regarding satisfaction. The "access" pediatrician evaluated and treated ∼40% of all new patients presenting to the division during the study period. Approximately 10% of new patients evaluated by the pediatrician (4% overall) were referred on to the subspecialist; fewer patients were reevaluated by the pediatrician in follow-up. The pediatrician ordered a minimal number of procedures. Semimonthly sampling revealed that overall new-patient access improved from an average time-to-appointment wait of 25 days to <1 day. Parent/family satisfaction was high for the patients evaluated by the pediatrician. Embedding a general pediatrician within a subspecialty division, and navigating patients to this provider, can increase access to treatment of new low- to moderate-complexity patients. The access pediatrician can maintain patient satisfaction, provide high-quality care, and decrease need for subspecialist evaluation. The model, in the setting of a large academic medical center, may provide a solution for barriers to patient care such as lengthy time-to-appointment wait.

P278 Reasons Proffered For Non-Attendance at a Difficult Asthma Clinic

BackgroundOur weekly difficult asthma clinic consistently has a higher ‘did not attend’ (DNA) rate compared to the general respiratory clinics (32.6% v 23.7%). There is some evidence that DNA rates...

Populations at risk: A new section for JGIM

Populations at risk: A new section for JGIM

Reorganization of a medical house staff (firm system): its effect on accessibility and continuity of care.

In 1975, the Johns Hopkins Medical house staff was reorganized into four Firms. Each Firm provides inpatient and outpatient care to a group of patients. Two of the goals of the reorganization were to improve accessibility and continuity of care. This study, based on a before and after research design utilizing routinely collected data, sought to determine whether these goals had been attained. Accessibility was assessed by observing changes in waiting time for appointments, broken appointments, and number of patients seen before their scheduled appointments. The results showed that mean waiting time for a Medical Clinic appointment fell from 15 days to 1 day (p < 0.01); broken appointments for new patients fell from 54% to 34% (p < 0.01); no significant changes occurred in broken appointments for old clinic patients (34% vs 32%); and patients seen before their scheduled appointments increased from 30% to 38% (p < 0.001). Continuity was assessed by observing changes in use of emergency and walk-in clinic services, the proportion of Medical Clinic patients lost to follow-up care, the proportion of hospital readmissions returning to the same nursing unit, and the proportion of patients discharged from the hospital who returned to the Medical Clinic. The results showed that use of emergency and walk-in clinic services fell slightly, from 24% of all visits before to 22% of all visits after the Firm System (p < 0.001); no change occurred in the proportion of patients lost to Medical Clinic follow-up (21% before and after the Firm System); the proportion of hospital readmissions returning to the same nursing unit increased from 35% to 73% (p < 0.005); and the proportion of patients discharged from the hospital who returned to the Medical Clinic increased from 21% to 35% (p < 0.001). These data suggest that implementing the Firm System led to improvement in several selected aspects of accessibility and continuity of care but that further improvements could be made.