Improving Clinical Access and Continuity through Physician Panel Redesign
Journal of General Internal MedicinePublished 11 June 2010Open access
Hari Balasubramanian, Ritesh Banerjee, A.G. de Kok, James M. Naessens, James E. Stahl
Citations40
SJR quartileQ1
SJR score1.99
SNIP1.71
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TL;DR
Redesigning primary care physician panels can improve access to and continuity of care for patients and provides shorter waiting time and higher continuity over a wide range of practice panel sizes.
Abstract
Redesigning primary care physician panels can improve access to and continuity of care for patients.
Keywords
Economics, Econometrics and FinanceHealth Professions
BiometricsClassification and Regression Trees.
23,841 Citations1984Alexander Gordon, Leo Breiman +3 more
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6,369 Citations2011John R. Birge, François Louveaux
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Journal of the Operational Research SocietyIntroduction to Stochastic Programming
1,669 Citations1998J M Wilson
Building a Better Delivery System: A New Engineering/Health Care Partnership
716 Citations2013Proctor P Reid, W. Dale Compton +2 more
JAMAAdvanced Access
619 Citations2003Mark Murray, Donald M. Berwick
Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources.
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A concerted attempt to provide a means of universal financial access as well as a medical home should be of high priority for the United States.
International Journal of Health ServicesQuantifying the Health Benefits of Primary Care Physician Supply in the United States
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390 Citations2001Arch G. Mainous, Richard Baker +3 more
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New England Journal of MedicinePrimary Care — Will It Survive?
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Archives of Family MedicineThe Role of Provider Continuity in Preventing Hospitalizations
386 Citations1998J. M. Gill
Continuity of care with a provider is associated with a decreased future likelihood of hospitalization in the Delaware Medicaid population, which suggests that policies that encourage patients to concentrate their care withA single provider may lead to lower hospitalization rates and possibly lower health care costs.
Archives of Family MedicineThe Effect of Continuity of Care on Emergency Department Use
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It is demonstrated that high provider continuity is associated with lower ED use for the Medicaid population, which suggests that strategies to improve continuity of care may result in lowerED use and possibly reduced health care costs.
New England Journal of MedicineGatekeeping Revisited — Protecting Patients from Overtreatment
330 Citations1992Peter Franks, Carolyn M. Clancy +1 more
The role of primary care physicians as gatekeepers in health maintenance organizations (HMOs) and their role is to authorize access to specialty, emergency, and hospital care and to diagnostically evaluate patients is studied.
Health AffairsWill Generalist Physician Supply Meet Demands Of An Increasing And Aging Population?
295 Citations2008Jack M. Colwill, James M. Cultice +1 more
It is predicted that population growth and aging will increase family physicians' and general internists' workloads by 29 percent between 2005 and 2025 and the supply of generalists for adult care will increase 7 percent, or only 2 percent if the number of graduates continues to decline through 2008.
PubMedSame-day appointments: exploding the access paradigm.
270 Citations2000Mark Murray, Catherine Tantau
To gain control over the schedule, you must do the unthinkable: Offer every patient an appointment for today.
JAMAImproving Timely Access to Primary Care
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4 case studies of primary care practices that successfully implemented advanced access and 3 examples of practices that were unable to achieve advanced access despite considerable efforts are described.
Health AffairsChanging The Chronic Care System To Meet People’s Needs
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Journal of the American Geriatrics SocietyEffectiveness of a Group Outpatient Visit Model for Chronically Ill Older Health Maintenance Organization Members: A 2‐Year Randomized Trial of the Cooperative Health Care Clinic
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A group outpatient model for chronically ill, older health maintenance organization (HMO) patients with usual care is compared to usual care to compare the effectiveness of this model.
Health AffairsChronic Care Costs In Managed Care
165 Citations1997Paul Fishman, Michael Von Korff +2 more
This DataWatch presents estimates of the health care costs for all adults who were continuously enrolled in a large staff-model health maintenance organization (HMO) during 1992, and it is important that economic analyses focus on this market segment.
Annals of Internal MedicineImplementing Open-Access Scheduling of Visits in Primary Care Practices: A Cautionary Tale
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PubMedPanel size: how many patients can one doctor manage?
110 Citations2007Mark Murray, Michael Davies +1 more
There are limits to the number of patients you can effectively care for, and here's how to determine that number, improve patient access and better manage your workload.
American Journal of Public HealthThe association between greater continuity of care and timely measles-mumps-rubella vaccination
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Greater continuity of care is associated with more timely immunization, and both medium continuity and high continuity were associated with increased likelihood of being immunized by 15 months compared with patients in the lowest tercile of continuity of Care.
The Joint Commission Journal on Quality and Patient SafetyProviding Timely Access to Care: What is the Right Patient Panel Size?
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The simple probability model can be used to improve the timeliness of care while considering the constraints on physicians' working hours.
PubMedRedefining open access to primary care.
86 Citations1999Mark Murray, Catherine Tantau
This Second Generation Open Access system offers an appointment today for any problem, exceeds all regulatory requirements for access, matches patients with their PCP at unprecedented rates, reduces overall utilization, and improves patient, staff, and physician satisfaction.
PubMedA controlled trial of an advanced access appointment system in a residency family medicine center.
81 Citations2004Francis G. Belardi, Sam Weir +1 more
Advanced access can enhance residency education by reducing appointment delays and significantly increasing the patient-primary care physician match and controlling for within-subject variation using repeated measures ANOVA eliminated this effect.
PubMedImpact of Advanced Access on access, workload, and continuity: controlled before-and-after and simulated-patient study.
79 Citations2007Chris Salisbury, Alan Montgomery +8 more
Advanced Access practices provided slightly shorter waits for an appointment compared with control practices, but performance against NHS access targets was considerably poorer than officially reported for both types of practice.
Anesthesia & AnalgesiaDesign of Appointment Systems for Preanesthesia Evaluation Clinics to Minimize Patient Waiting Times: A Review of Computer Simulation and Patient Survey Studies
77 Citations1999Franklin Dexter
Efforts to decrease the mean patient waiting time in anesthesia clinics should focus foremost on minimizing the mean consultation time and its variability, which can most likely be achieved by assuring that providers have rapid access to relevant clinical information, including external medical records, surgical dictations, etc.
The Journal of PediatricsContinuity of pediatrician: New support for an old shibboleth
77 Citations1974Marshall H. Becker, Robert H. Drachman +1 more
Results of a survey of all staff and a sample of patients' mothers indicated that provision of pediatrician continuity yields higher staff and client satisfaction, better patient-practitioner relationships, and greater efficiency.
BMC Family PracticeHealth care restructuring and family physician care for those who died of cancer
75 Citations2005Fred Burge, Beverley Lawson +2 more
Despite hospital downsizing and fewer deaths occurring in hospitals, FP ambulatory visits (except for ED visits) did not rise correspondingly and it does not appear FPs responded by providing more medical care to them in the community.
PubMedThe outcomes of open-access scheduling.
71 Citations2004Christine O’Hare, J. Corlett
The author describes implementing open access in 12 pilot clinics and provides data to support the positive impact open access has had on the health care system in which he works.
Journal of General Internal MedicineImproving outpatient clinic staffing and scheduling with computer simulation
68 Citations1996Fred Hashimoto, Stoughton Bell
Patient flow in an appointment-based, outpatient internal medicine clinic involving multiple, sequential providers—registrar, triage nurse, physician, and discharger—was studied using computer simulation, which yielded insights into staffing levels, appointment times, and clinic dynamics.
International Journal of Health Care Quality AssuranceImproving outpatient clinic efficiency using computer simulation
63 Citations1997John E. Clague, Patrick G. Reed +4 more
It was found that patient waiting time could be shortened considerably by using an optimizing appointment scheduler to determine appointment intervals and in mixed clinics, waiting time is improved if the appointment interval reflects the consultation time.
BMJ Quality & SafetyUsing computer simulation to reduce access time for outpatient departments
59 Citations2007Sylvia Elkhuizen, S. Das +2 more
The analytical model provided quick insight into the extra capacity needed for the neurology department and the added value of the simulation model was the possibility of taking into account variations in demand for different weekdays and a realistic schedule for doctors’ consultations.
Anesthesia & AnalgesiaDesign of Appointment Systems for Preanesthesia Evaluation Clinics to Minimize Patient Waiting Times: A Review of Computer Simulation and Patient Survey Studies
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PubMedDecreased continuity in a residency clinic: a consequence of open access scheduling.
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Continuity of care decreased in a family medicine residency clinic after implementation of open access scheduling, which has implications for all primary care residency training programs since one of the hallmarks of primary care is maintaining continuity in the physician-patient relationship.
Journal of Management in MedicineManagement of queues in out‐patient departments: the use of computer simulation
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British Journal of AnaesthesiaSimulation to analyse planning difficulties at the preoperative assessment clinic
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Journal of General Internal MedicineOptimizing management and financial performance of the teaching ambulatory care clinic
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Journal of Health Services Research & PolicyImproving access to primary care: Eight case studies of introducing Advanced Access in England
31 Citations2008Catherine Pope, Jonathan Banks +2 more
Advanced Access was diluted because it became confused with same-day appointment systems and other incentives and targets and as a result, the system was adapted and modified.
PubMedThe effect of advanced access implementation on quality of diabetes care.
25 Citations2008JoAnn M. Sperl‐Hillen, Leif I. Solberg +4 more
Moves of the quality of diabetes control improved in the year after implementation of advanced access, but better care did not correlate with decreased wait time to see a provider, and improved continuity of care predicted improvements in both process and quality ofabetes care.
Health Services Management ResearchImpact of open-access scheduling on realized access
22 Citations2007James E. Rohrer, Matthew Bernard +4 more
It is hypothesized that the odds that a continuing patient received more than one primary care visit would be greater in the clinic where open-access scheduling was in use than in comparison clinics, and the study provides mixed support for the hypotheses.
BMC Family PracticeFollow-up care by patient's own general practitioner after contact with out-of-hours care. A descriptive study
20 Citations2005Caro JT van Uden, P. J. Zwietering +5 more
Almost half of all patients in this study who contacted the GP cooperative for out-of-hours care attended their own GP during office hours within a week, for the same medical complaint.
Medical Care Research and ReviewThe Role of Disease Management in Pay-for-Performance Programs for Improving the Care of Chronically Ill Patients
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