Implementing Open-Access Scheduling of Visits in Primary Care Practices

A Cautionary Tale

Published In: Annals of Internal Medicine, v. 148, no. 12, June 2008, p. 915-922

Posted on RAND.org on January 01, 2008

by Ateev Mehrotra, Lori Keehl-Markowitz, John Z. Ayanian

Read More

Access further information on this document at www.annals.org

This article was published outside of RAND. The full text of the article can be found at the link above.

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.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.