Open Access Appointment

Scheduling: Impact on Physicians & Patients

Mark Linzer, MD

Linda Baier Manwell, MS

Roger Brown, PhD

James Bobula, PhD

Eric Williams, PhDUniversity of Wisconsin-Madison & University of Alabama-

Tuscaloosa

Background on Open Access

Developed to improve patient access to care

Shown to improve: Missed appts for well-child visits & on-time immunizations

(O’Connor, 2006) Operational efficiency (Parente, 2005; O’Hare, 2004) Days between appt scheduling/being seen by an MD

(Parente, 2005; O’Hare, 2004) Continuity with primary MD (Parente, 2005; O’Hare, 2004) Increased MD compensation (O’Hare, 2004)

Background on Open Access

Conflicting evidence for patient satisfaction: No significant difference in patient satisfaction

(Parente, 2005)

Improved patient satisfaction (O’Hare, 2004)

Theoretically, open access will increase MD stress while working off the backlog; stress and satisfaction will improve thereafter.

Aims

To assess the impact of open access on MD stress and satisfaction

To assess the impact of open access on patient satisfaction

MEMO Study

Longitudinal, observational study of 422 general internists and family physicians

97 clinics in 5 regions: New York City, Chicago, Milwaukee area, Madison area, and rural/small town Wisconsin

Impact of the healthcare work environment on quality of care and role of physicians as mediators of this effect

1795 patients with hypertension, diabetes and/or CHF

MEMO Conceptual Model

WorkplaceCharacteristic

s

Structure

Culture

Workflow

Policies,

processes

Patient

demands

Patient satisfaction

Quality of care

Medical errors

Burnout

Mental health issues

MD

Stress

MD Satisfaction

MEMO Measures

Physician survey Work environment Mental health Job satisfaction Open access appointment scheduling

(y/n)

Patient survey Satisfaction with physician Satisfaction with clinic Trust in physician

Work-induced stress Time pressure Work control: e.g.

Deciding when to admit patients to the hospital Details of clinic schedule Hours worked Work interruptions Patient load Work pace

Intent to leave within 2 years Job satisfaction

MEMO Measures

422 primary care physicians (84.4% of target 500)

59.2% of those surveyed responded

51% GIM 49% FP

44% female

83% white

83% full-time

Age 44 (range 29-89)

Physician Participants

Results: Open Access

62 physicians stated they had open access 48% GIM 52% FP

113 physicians did not have open access 247 either didn’t specify, or physicians

within the clinic didn’t agree Duration of open access: 1-60 months

mean = 18 months (SD=13.22)

Results: MD Outcomes in Open Access Clinics

Lower MD stress in open access clinics (p<.05)

Less time pressure in open access clinics (p<.05)

More work control in open access clinics p<.05)

Less intent to leave in open access clinics p<.05)

Similar job satisfaction among all MDs

Of 788 patients with chronic conditions:

246 from open access clinics

542 not from open access clinics

Similar rates of satisfaction with the MD

Similar rates of satisfaction with the clinic

Similar rates of trust in the MD

Results: Patient Outcomes

Impact of Duration of Open Access

After controlling for MD age, gender, and other predictors of MD stress and job satisfaction...

The relationship between amount of time in open access and physician stress and satisfaction were negligible

The favorable impact of simply being in an open access clinic on MD stress and stressors was maintained

Next Steps

Determine the impact of open access on other patient outcomes: Disease control Medical errors Preventive care

Limitations

50% of physicians did not specify if open access available in their clinics

Open access has evolved in some cases into “advanced access” (different structure)

Only 5 regions included (NYC and upper Midwest)

Self-reported data

Conclusions

Open access is beneficial to physician worklife

Open access has little impact on satisfaction for patients with chronic conditions

Further analysis is necessary to determine the impact of open access on other patient outcomes

ConsultantsEric Williams Bob Konrad Elianne RiskaBill SchecklerStewart Babbott JudyAnn BigbyPeggy LeattSaid Ibrahim Jacqueline Wiltshire

MEMO Staff Jim Bobula Marlon Mundt Roger Brown Carolyn Egan

Chicago Region Anita Varkey Bernice Man Elizabeth Arce

Milwaukee Region Ann Maguire Barb Horner-Ibler Laura Paluch

Rural/Small Town WI Mary Beth Plane John Frey Jessica Grettie Mary Lamon-Smith

Madison Region Julia McMurray Jessica Sherrieb James Gesicki

New York Region Mark Schwartz Joe Rabatin Karla Felix Debby Dowell

MEMO Team