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DOI: 10.4338/ACI-2016-03-RA-0044
Appointment Lead Time Policy Development to Improve Patient Access to Care
Correspondence to:
Publikationsverlauf
received:
28. März 2016
accepted:
10. September 2016
Publikationsdatum:
18. Dezember 2017 (online)
Summary
Background Patient access to care has been a known and continuing struggle for many health care providers. In spite of appointment lead time policies set by government or clinics, the problem persists. Justification for how lead time policies are determined is lacking.
Objectives This paper proposed a data-driven approach for how to best set feasible appointment target lead times given a clinic’s capacity and appointment requests.
Methods The proposed approach reallocates patient visits to minimize the deviation between actual appointment lead time and a feasible target lead time. A step-by-step algorithm was presented and demonstrated for return visit (RV) and new patient (NP) types from a Pediatric clinic excluding planned visits such as well-child exam and the same day urgent appointments. The steps are: 1. Obtain appointment requests; 2. Initialize a target lead time; 3. Set up an initial schedule; 4. Check the feasibility based on appointment availability; 5. Adjust schedule backward to fill appointment slots earlier than the target; 6. Adjust schedule forward for appointments not able to be scheduled earlier or on target to the later slots; 7. Trial different target lead times until the difference between earlier and later lead time is minimized.
Results The results indicated a 59% lead time reduction for RVs and a 45% reduction for NPs. The lead time variation was reduced by 75% for both patient types. Additionally, the opportunity for the participating clinic to achieve their organization’s goal of a two-week lead time for RVs and a twoday lead time for NPs is discussed by adjusting capacity to increase one slot for NP and reduce one slot for RV.
Conclusions The proposed approach and study findings may help clinics identify feasible appointment lead times.
Citation: Huang Y, Bach SM. Appointment lead time policy development to improve patient access to care.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Norris S. The Wait Times Issue and The Patient Wait Times Guarantee. Social Affairs Division. Parliament of Canada. 2009
- 2 Thomson S, Osborn R, Squires D, Jun M. International Profiles of Health Care Systems. The Commonwealth Fund. 2013
- 3 Steedman NM, Worsnop V, Fernie R. Acceptance of genitourinary medicine clinic appointments within 48 hours is influenced by patient perception of risk but not by symptoms. Int J STD AIDS 2009; 20 (09) 644-646.
- 4 Pacifico MD, Pearl RA, Grover R. The UK Government two-week rule and its impact on melanoma prognosis: an evidence-based study. Ann R Coll Surg Engl 2007; 89 (06) 609-615.
- 5 UK Department of Health. The NHS Outcomes Framework 2014/2015. 2013
- 6 Kaplan G, Lopez MH, McGinnis JM. Transforming Health Care Scheduling and Access: Getting to Now. Committee on Optimizing Scheduling in Heatlh Care; Institute of Medicine, editors. Washington, DC: The National Academies Press; 2015
- 7 Dobson G, Hasija S, Pinker EJ. Reserving Capacity for Urgent Patients in Primary Care. Prod Oper Manag 2011; 20 (03) 456-473.
- 8 Huang Y, Zuniga P, Marcak J. A cost-effective urgent care policy to improve patient access in a dynamic scheduled clinic setting. J Oper Res Soc 2014; 65 (05) 763-776.
- 9 Qua X, Rardina RL, Williamsb JS, Willisc DR. Matching daily healthcare provider capacity to demand in advanced access scheduling systems. Eur J Oper Res 2007; 183 (02) 812-826.
- 10 Harper PR, Gamlin HM. Reduced outpatient waiting times with improved appointment scheduling: a simulation modelling approach. OR Spectrum 2003; 25 (02) 207-222.
- 11 Robinson LW, Chen RR. Scheduling doctors’ appointments: optimal and empirically-based heuristic policies. IIE Trans 2003; 35 (03) 295-307.
- 12 Huang Y, Hancock WM, Herrin GD. An alternative outpatient scheduling system: Improving the outpatient experience. IIE Trans Healthc Syst Eng 2012; 02 (02) 97-111.
- 13 Qu X, Peng Y, Kong N, Shi J. A two-phase approach to scheduling multi-category outpatient appointments – a case study of a women’s clinic. Health Care Manag Sci 2013; 16 (03) 197-216.
- 14 Vanden PMBosch, Dietz DC. Minimizing expected waiting in a medical appointment system. IIE Trans 2000; 32 (09) 841-848.
- 15 Huang Y, Verduzco S. Appointment Template Redesign in a Women’s Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency. Appl Clin Inform 2015; 06 (02) 271-287.
- 16 Santibáñez P, Chow VS, French J, Puterman ML, Tyldesley S. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation. Health Care Manag Sci 2009; 12 (04) 392-407.
- 17 Kopach R, DeLaurentis PC, Lawley M, Muthuraman K, Ozsen L, Rardin R, Wan H, Intrevado P, Qu X, Willis D. Effects of clinical characteristics on successful open access scheduling. Health Care Manag Sci 2007; 10 (02) 111-124.
- 18 Liu N, Ziya S, Kulkarni VG. Dynamic scheduling of outpatient appointments under patient no-Shows and cancellations. Manuf Serv Oper Manag 2010; 12 (02) 347-364.
- 19 Huang Y, Hanauer DA. Patient No-Show Predictive Model Development using Multiple Data Sources for an Effective Overbooking Approach. Appl Clin Inform 2014; 05 (03) 836-860.
- 20 Kim S, Giachetti RE. A Stochastic Mathematical Appointment Overbooking Model for Healthcare Providers to Improve Profits. IEEE Trans Syst Man Cybern 2006; 36 (06) 1211-1219.
- 21 Huang Y, Zuniga P. Dynamic overbooking scheduling system to improve patient access. J Oper Res Soc 2012; 63 (06) 810-820.
- 22 Robinson LW, Chen RR. A Comparison of Traditional and Open-Access Policies for Appointment Scheduling. Manuf Serv Oper Manag 2010; 12 (02) 330-346.
- 23 Murray M, Bodenheimer T, Rittenhouse D, Grumbach K. Improving timely access to primary care: case studies of the advanced access model. JAMA 2003; 289 (08) 1042-1046.
- 24 Mehrotra A, Keehl-Markowitz L, Ayanian JZ. Implementing open-access scheduling of visits in primary care practices: a cautionary tale. Ann Intern Med 2008; 148 (12) 915-922.
- 25 Silvester KLR, Richard L, Bevan H, Steyn RS, Walley P. Reducing waiting times in the NHS: is lack of capacity the problem?. Clinician Manag 2004; 12 (03) 105-111.
- 26 Patrick J. A Markov decision model for determining optimal outpatient scheduling. Health Care Manag Sci 2012; 15 (02) 91-102.
- 27 Gocgun Y, Puterman ML. Dynamic scheduling with due dates and time windows: an application to chemotherapy patient appointment booking. Health Care Manag Sci 2014; 17 (01) 60-76.
- 28 Matteson-Kome ML, Lopez KT, Sliger AD, Mathews MJ, Bechtold ML. Improving care access for new patients in an outpatient gastroenterology clinic: a novel approach. Mo Med 2014; 111 (06) 512-515.
- 29 Snow BW, Cartwright PC, Everitt S, Ekins M, Maudsley W, Aloi S. A method to improve patient access in urological practice. J Urol 2009; 182 (02) 663-667.
- 30 O’Neill S, Calderon S, Casella J, Wood E, Carvelli-Sheehan J, Zeidel ML. Improving outpatient access and patient experiences in academic ambulatory care. Acad Med 2012; 87 (02) 194-199.
- 31 Hanning M, Spangberg UW. Maximum wait time – a threat to clinical freedom? Implementation of a policy to reduce waiting times. Health Policy 2000; 52 (01) 15-32.
- 32 Calltorp J. Priority setting in health policy in Sweden and a comparison with Norway. Health Policy 1999; 50 (1–2): 1-22.
- 33 Hole AR. Modelling heterogeneity in patients’ preferences for the attributes of a general practitioner appointment. J Health Econ 2008; 27 (04) 1078-1094.
- 34 Dexter F, Macario A, Traub RD, Hopwood M, Lubarsky A. An Operating Room Scheduling Strategy to Maximize the Use of Operating Room Block Time: Computer Simulation of Patient Scheduling and Survey of Patients’ Preferences for Surgical Waiting Time. Anesth Analg 1999; 89 (01) 7-20.
- 35 Conner-Spady BL, Sanmartin C, Johnston GH, McGurran JJ, Kehler M, Noseworthy TW. The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery. Health Policy 2011; 101 (03) 245-252.
- 36 Rubin G, Bate A, George A, Shackley P, Hall N. Preferences for access to the GP: a discrete choice experiment. Brit J Gen Pract 2006; 56 (531) 743-748.
- 37 Turner D, Tarrant C, Windridge K, bryan S, Boulton M, Freeman G, Baker R. Do patients value continuity of care in general practice? An investigation using stated preference discrete choice experiments. J Health Serv Res Policy 2007; 12 (03) 132-137.
Correspondence to:
-
References
- 1 Norris S. The Wait Times Issue and The Patient Wait Times Guarantee. Social Affairs Division. Parliament of Canada. 2009
- 2 Thomson S, Osborn R, Squires D, Jun M. International Profiles of Health Care Systems. The Commonwealth Fund. 2013
- 3 Steedman NM, Worsnop V, Fernie R. Acceptance of genitourinary medicine clinic appointments within 48 hours is influenced by patient perception of risk but not by symptoms. Int J STD AIDS 2009; 20 (09) 644-646.
- 4 Pacifico MD, Pearl RA, Grover R. The UK Government two-week rule and its impact on melanoma prognosis: an evidence-based study. Ann R Coll Surg Engl 2007; 89 (06) 609-615.
- 5 UK Department of Health. The NHS Outcomes Framework 2014/2015. 2013
- 6 Kaplan G, Lopez MH, McGinnis JM. Transforming Health Care Scheduling and Access: Getting to Now. Committee on Optimizing Scheduling in Heatlh Care; Institute of Medicine, editors. Washington, DC: The National Academies Press; 2015
- 7 Dobson G, Hasija S, Pinker EJ. Reserving Capacity for Urgent Patients in Primary Care. Prod Oper Manag 2011; 20 (03) 456-473.
- 8 Huang Y, Zuniga P, Marcak J. A cost-effective urgent care policy to improve patient access in a dynamic scheduled clinic setting. J Oper Res Soc 2014; 65 (05) 763-776.
- 9 Qua X, Rardina RL, Williamsb JS, Willisc DR. Matching daily healthcare provider capacity to demand in advanced access scheduling systems. Eur J Oper Res 2007; 183 (02) 812-826.
- 10 Harper PR, Gamlin HM. Reduced outpatient waiting times with improved appointment scheduling: a simulation modelling approach. OR Spectrum 2003; 25 (02) 207-222.
- 11 Robinson LW, Chen RR. Scheduling doctors’ appointments: optimal and empirically-based heuristic policies. IIE Trans 2003; 35 (03) 295-307.
- 12 Huang Y, Hancock WM, Herrin GD. An alternative outpatient scheduling system: Improving the outpatient experience. IIE Trans Healthc Syst Eng 2012; 02 (02) 97-111.
- 13 Qu X, Peng Y, Kong N, Shi J. A two-phase approach to scheduling multi-category outpatient appointments – a case study of a women’s clinic. Health Care Manag Sci 2013; 16 (03) 197-216.
- 14 Vanden PMBosch, Dietz DC. Minimizing expected waiting in a medical appointment system. IIE Trans 2000; 32 (09) 841-848.
- 15 Huang Y, Verduzco S. Appointment Template Redesign in a Women’s Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency. Appl Clin Inform 2015; 06 (02) 271-287.
- 16 Santibáñez P, Chow VS, French J, Puterman ML, Tyldesley S. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation. Health Care Manag Sci 2009; 12 (04) 392-407.
- 17 Kopach R, DeLaurentis PC, Lawley M, Muthuraman K, Ozsen L, Rardin R, Wan H, Intrevado P, Qu X, Willis D. Effects of clinical characteristics on successful open access scheduling. Health Care Manag Sci 2007; 10 (02) 111-124.
- 18 Liu N, Ziya S, Kulkarni VG. Dynamic scheduling of outpatient appointments under patient no-Shows and cancellations. Manuf Serv Oper Manag 2010; 12 (02) 347-364.
- 19 Huang Y, Hanauer DA. Patient No-Show Predictive Model Development using Multiple Data Sources for an Effective Overbooking Approach. Appl Clin Inform 2014; 05 (03) 836-860.
- 20 Kim S, Giachetti RE. A Stochastic Mathematical Appointment Overbooking Model for Healthcare Providers to Improve Profits. IEEE Trans Syst Man Cybern 2006; 36 (06) 1211-1219.
- 21 Huang Y, Zuniga P. Dynamic overbooking scheduling system to improve patient access. J Oper Res Soc 2012; 63 (06) 810-820.
- 22 Robinson LW, Chen RR. A Comparison of Traditional and Open-Access Policies for Appointment Scheduling. Manuf Serv Oper Manag 2010; 12 (02) 330-346.
- 23 Murray M, Bodenheimer T, Rittenhouse D, Grumbach K. Improving timely access to primary care: case studies of the advanced access model. JAMA 2003; 289 (08) 1042-1046.
- 24 Mehrotra A, Keehl-Markowitz L, Ayanian JZ. Implementing open-access scheduling of visits in primary care practices: a cautionary tale. Ann Intern Med 2008; 148 (12) 915-922.
- 25 Silvester KLR, Richard L, Bevan H, Steyn RS, Walley P. Reducing waiting times in the NHS: is lack of capacity the problem?. Clinician Manag 2004; 12 (03) 105-111.
- 26 Patrick J. A Markov decision model for determining optimal outpatient scheduling. Health Care Manag Sci 2012; 15 (02) 91-102.
- 27 Gocgun Y, Puterman ML. Dynamic scheduling with due dates and time windows: an application to chemotherapy patient appointment booking. Health Care Manag Sci 2014; 17 (01) 60-76.
- 28 Matteson-Kome ML, Lopez KT, Sliger AD, Mathews MJ, Bechtold ML. Improving care access for new patients in an outpatient gastroenterology clinic: a novel approach. Mo Med 2014; 111 (06) 512-515.
- 29 Snow BW, Cartwright PC, Everitt S, Ekins M, Maudsley W, Aloi S. A method to improve patient access in urological practice. J Urol 2009; 182 (02) 663-667.
- 30 O’Neill S, Calderon S, Casella J, Wood E, Carvelli-Sheehan J, Zeidel ML. Improving outpatient access and patient experiences in academic ambulatory care. Acad Med 2012; 87 (02) 194-199.
- 31 Hanning M, Spangberg UW. Maximum wait time – a threat to clinical freedom? Implementation of a policy to reduce waiting times. Health Policy 2000; 52 (01) 15-32.
- 32 Calltorp J. Priority setting in health policy in Sweden and a comparison with Norway. Health Policy 1999; 50 (1–2): 1-22.
- 33 Hole AR. Modelling heterogeneity in patients’ preferences for the attributes of a general practitioner appointment. J Health Econ 2008; 27 (04) 1078-1094.
- 34 Dexter F, Macario A, Traub RD, Hopwood M, Lubarsky A. An Operating Room Scheduling Strategy to Maximize the Use of Operating Room Block Time: Computer Simulation of Patient Scheduling and Survey of Patients’ Preferences for Surgical Waiting Time. Anesth Analg 1999; 89 (01) 7-20.
- 35 Conner-Spady BL, Sanmartin C, Johnston GH, McGurran JJ, Kehler M, Noseworthy TW. The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery. Health Policy 2011; 101 (03) 245-252.
- 36 Rubin G, Bate A, George A, Shackley P, Hall N. Preferences for access to the GP: a discrete choice experiment. Brit J Gen Pract 2006; 56 (531) 743-748.
- 37 Turner D, Tarrant C, Windridge K, bryan S, Boulton M, Freeman G, Baker R. Do patients value continuity of care in general practice? An investigation using stated preference discrete choice experiments. J Health Serv Res Policy 2007; 12 (03) 132-137.