Implementing Open-Access Scheduling of Visits in Primary Care Practices: A Cautionary Tale

17 June 2008 | Volume 148 Issue 12 | Pages 915-922

Background: Open-access scheduling (also known as advanced access or same-day access) is a popular tool for improving patient access to primary care appointments.

Objective: To assess the effect of open-access scheduling and describe the barriers to implementing the open-access scheduling model in primary care.

Design: Case series.

Setting: Boston, Massachusetts, metropolitan area.

Participants: 6 primary care practices studied from October 2003 through June 2006.

Intervention: Implementation of open-access scheduling.

Measurements: Time to third available appointments, no-show rates, and patient and staff satisfaction with appointment availability.

Results: 5 of 6 practices were able to implement open-access scheduling. Within 4 months of implementation, these 5 practices substantially reduced their mean wait for third available appointments from 21 to 8 days for 15-minute visits and from 39 to 14 days for 30-minute visits. However, none of the 5 practices attained the goal of same-day access, and waits for third available appointments increased during 2 years of follow-up. No consistent changes in patient or staff satisfaction or patient no-show rates were found. Barriers to implementation included decreases in appointment supply from provider leaves of absence and departures and increases in appointment demand when practices reopened to new patients after initial implementation of open-access scheduling.

Limitations: The study lacked control practices. The small number of practices and providers precluded formal statistical comparisons.

Conclusion: In 5 of 6 primary care practices, implementation of open-access scheduling improved appointment access in some practices. However, none was able to achieve same-day access and patient and staff satisfaction and patient no-show rates were unchanged. Broader evaluation of open-access scheduling in primary care is needed.

Editors' Notes Context Open-access scheduling offers appointments to patients at or close to a time of their choosing. Contribution The authors helped 6 primary care practices implement open-access scheduling. Five of the 6 reduced waiting times for appointments, but none could provide same-day access or sustain the initial reductions over time. Also, patient and staff satisfaction was unchanged and no-show rates remained the same. Caution Implementation of the system differed too much among the practices to formally compare its effects. Implication Open-access scheduling improves appointment access. However, not all practices can implement it and it has variable effects in those that can. —The Editors

 

Author and Article Information

From the University of Pittsburgh School of Medicine and RAND Health, Pittsburgh, Pennsylvania, and Partners Community Healthcare, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts.

Acknowledgment: The authors thank the staff of the participating practices and the project steering committee for their time and effort. They also thank Lisa Noke, Jessica Desrosiers, and other staff at Partners Community Healthcare for their invaluable assistance with data collection and analysis.

Grant Support: By internal funding from Partners HealthCare. Dr. Mehrotra was supported by a National Research Service Award from the Health Resources and Services Administration (5 T32 HP11001-15) and by the National Center for Research Resources, a component of the National Institutes of Health (KL2-RR024154-01).

Potential Financial Conflicts of Interest: Employment: A. Mehrotra (Massachusetts General Hospital), L. Keehl-Markowitz (Partners Community Healthcare).

Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Mehrotra (e-mail, mehrotra{at}rand.org). Data set: Not available.

Requests for Single Reprints: Ateev Mehrotra, MD, MPH, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213; e-mail, mehrotra{at}rand.org.

Current Author Addresses: Dr. Mehrotra: Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213.

Ms. Keehl-Markowitz: Crotched Mountain Rehabilitation Hospital, One Verney Drive, Greenfield, NH 03047.

Dr. Ayanian: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899.

Author Contributions: Conception and design: A. Mehrotra, J.Z. Ayanian.

Analysis and interpretation of the data: A. Mehrotra, J.Z. Ayanian.

Drafting of the article: A. Mehrotra.

Critical revision of the article for important intellectual content: L. Keehl-Markowitz, J.Z. Ayanian.

Final approval of the article: A. Mehrotra, J.Z. Ayanian.

Administrative, technical, or logistic support: L. Keehl-Markowitz.

Collection and assembly of data: L. Keehl-Markowitz.

Read all Rapid Responses

Open-Access Scheduling of Visits to Primary Care Practices: A Challenge Unmet

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Annals Online, 20 Jun 2008 [Full text]

Cautions about a Cautionary Tale

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Advanced Access Works, but only when implemented effectively

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In Reply:

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