Innovations in Access to Care: A Patient-Centered Approach

7 October 2003 | Volume 139 Issue 7 | Pages 568-574

To receive health care, patients with nonemergent problems must gain access to a complex, interdependent ambulatory care system currently structured around the conventional office appointment model. The system does not effectively accommodate diverse patient needs and preferences, contributing to both overuse and underuse of health care resources. A patient-centered access model would help patients secure appropriate and preferred medical assistance when and where it is needed. Characteristics of patient-centered access include availability, appropriateness, preference, and timeliness. One or more of these characteristics often is missing in patients' health care experiences.

The goal of this paper is to present patient-centered access as an integrated concept and philosophy to provide context for evaluating specific access initiatives. On the basis of an assessment of existing literature, 3 organizing principles of patient-centered access are proposed and discussed: work at the high end of expertise; align care with need and preference; and serve when service is needed. Patient-centered access warrants serious consideration, given the stakes involved for patients, providers, and payers. Few concepts support all 6 of the Institute of Medicine's aims for the 21st century: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitability. Patient-centered access is such a concept.

Author and Article Information

From Texas A&M University, College Station, Texas; Boston College, Chestnut Hill, Massachusetts; and Mayo Clinic Scottsdale, Scottsdale, Arizona.

Acknowledgments: The authors thank Frank Davidoff, MD, Executive Editor, The Institute for Healthcare Improvement, and 3 anonymous reviewers for their detailed and constructive suggestions on earlier drafts of this paper. The guidance of Jane Roessner of The Institute for Healthcare Improvement Publications Group is appreciated, as is the research assistance of Ann Mirabito and Jed Grisel, students in Texas A&M University's marketing PhD program and medical school, respectively.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Leonard L. Berry, PhD, Department of Marketing, Mays Business School, Texas A&M University, 4112 TAMU, College Station, TX 77843-4112; e-mail, BerryLe{at}tamu.edu.

Current Author Addresses: Dr. Berry: Department of Marketing, Mays Business School, Texas A&M University, 4112 TAMU, College Station, TX 77843-4112.

Dr. Seiders: Carroll School of Management, Boston College, Fulton Hall, 4th Floor, Chestnut Hill, MA 02467.

Dr. Wilder: Mayo Thunderbird Family Medicine Center, 13737 North 92nd Street, Scottsdale, AZ 85260.