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Research Questions

  1. What are the key features of access management, and what defines optimal access in health care delivery organizations?
  2. From among the many aspects of access management, what are the key priorities for improving access management and achieving optimal access?
  3. What evidence-based recommendations for action and suggestions for implementation would support the achievement of each identified key access management priority?

Effective access to primary care is critical for ensuring population health. This project focused on identifying evidence-based access management priorities for health care organizations as they undertake initiatives to improve access.

The priorities are based on evidence review, qualitative analysis, and the deliberations of an expert panel using a modified Delphi approach. Twenty panelists included patients, providers, policymakers, purchasers, researchers, product makers, and payers representing a variety of health care settings and perspectives. The panelists were provided a systematic evidence review and a qualitative study of Veterans Health Administration experiences with access management as background to respond to a pre-panel survey assessing 85 aspects of access management. Panelists then participated in two days of in-person panel discussion, aimed at developing consensus around access management priorities. In a post-panel survey, panelists endorsed eight access management priorities addressing organizational structures, processes, and outcomes as both urgent and important. The process also resulted in consensus around definitions of access management, optimal access management, and optimal access. With these definitions, the panelists balance competing access-related goals rather than attempt to define access in absolute terms.

In follow-up meetings, panelists identified evidence-based recommendations for action and suggestions for implementing each of the eight priorities. The report is accompanied by a ready-to-use tool for access management improvement.

Key Findings

The panel identified eight evidence-based access management priorities endorsed by panelists as both important and urgent for achieving optimal access.

  • Routinely evaluate the degree to which patient telephone calls are (a) answered promptly and (b) routed accurately and appropriately, as judged in terms of patients' clinical needs and preferences.
  • Assess the quality of the patient's experiences of access. Patient ratings should reflect both in-person and non-face-to-face (e.g., telehealth, telephone, secure messaging) care.
  • Develop a clearly identified group practice management structure with a designated group practice manager who reports to executive leadership, communicates with individual primary care sites, and can collaborate across roles and service lines (e.g., medicine, nursing, administration).
  • Identify physician, registered nurse, and administrative leaders for each primary care practice site with authority to support access management priorities within local site contexts.
  • Maximize access managers' routine use or ability to demonstrate systematic approaches to ensuring adequate availability of contingency staffing (i.e., planned minimal excess staffing to cover routine absences).
  • Maximize the ability of the primary care team's registered nurses to prospectively manage demand by leading care coordination for their panels.
  • Assess primary care provider and staff morale (e.g., low/high burnout, job satisfaction, or turnover rates) in relation to access mismatch (e.g., panels exceeding recommended size, primary care provider vacancies).
  • Maximize primary care team members' ability to proactively manage demand (e.g., alerts, reminders, and telephone contacts from patients on their panels) by optimizing provider visit schedules (e.g., through triage, prospective "scrubbing" of appointments to the extent appropriate given their training/licenses).

Recommendations

  • This project supports access management improvement by providing evidence-based recommendations for health care organizations. For each of the eight access management priorities, the project has formulated recommendations for action. In addition, the recommendations were translated into numerous concrete suggestions for implementation.
  • The project report includes a ready-to-use access management tool. In addition to the recommendations and the suggestions for implementation, the tool specifies the organizational level at which the change is best initiated. Each recommendation is followed by literature references and further reading suggestions.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Flow Chart of Patient Access to Primary Care and Characteristics Affecting Achievement of Optional Access

  • Appendix B

    Literature Collection Informing the Recommendations and Suggestions for Implementation

  • Appendix C

    Survey

  • Appendix D

    Results for Critical Items Pre- and Post-Panel Survey

  • Appendix E

    Access Management Improvement Tool

The research described in this report was sponsored by the U.S. Department of Veterans Affairs and conducted by RAND Health.

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