Managing Patient Appointments in Primary Care

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 over utilization 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 21 st 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.