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Access to Continuity Change Package Summary

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What is the purpose?

To assist patient’s medical homes to optimize access processes, so patients can receive care when they want or need it. ​

What is the aim statement?

By x date, patient continuity to the primary care physician and team is greater than 80% and patients can be offered a same or next day appointment for any primary care related need as measured by Third Next Available Appointment (TNA )(TNA ≤1).

What is the outcome measure?

Each primary care physician and team have high relational continuity (≥80%) & low TNA (≤1 day).

What constitutes the balancing measure?

Physician and patient satisfaction (goal: maintained or improved)

What do I need to do before proceeding?

This is the prerequisite change package that should be reviewed:

Panel Processes Change Package Summary

High Impact Changes

  1. Improve the patient experience

    Potentially Better Practice

    1.1 Establish an interdisciplinary improvement team and consider including a patient with lived experience. 

    Process Measure

    • Team meetings are scheduled regularly.

    Tools

    Sequence to Achieve Change Sequence to Achieve Change Example - Access Patient Partner Guide
    Potentially Better Practice

    1.2 Commit to access to continuity as a team.

    Process Measure

    • Have met as a team to discuss the benefits of improved access

  2. Know your paneled patients

    Potentially Better Practice

    2.1 Review the physician’s panel and how patients access primary care inside and outside of the practice.

    Process Measures

    • Review CII/CPAR portal:
      • of patients on panel
      • % of patients in conflict
    • Review HQCA report:
      • Average annual visits for panel
      • Average physician continuity over time

    Tools

    HQCA Panel Report Understanding HQCA Continuity Data Online Module
    Potentially Better Practice

    2.2 Assess the balance of supply and demand for appointments by provider to identify key improvement strategies

    Process Measures

    • Third Next Available Appointment
    • Panel Size
    • Supply
    • Demand

    Tools

    Ideal Panel Size Worksheet Data Tracker - DSA, No Show, TNA

  3. Coordinate care in the medical home by enhancing team-based care

    Potentially Better PracticeS

    3.1 Establish clear roles and responsibilities for clinic processes and enable all team members to work to full scope

    Process Measure

    • Roles and responsibilities guide completed

    Tools

    Roles and Responsibilities - Enhanced Access Introductions with Intention Team Huddles Guide Process Mapping

     

  4. Manage demand for care

    Potentially Better PracticeS

    4.1 Identify strategies to reduce the return visit rate

    Process Measure

    • Return visit rate

    Tools

    Max Packing Strategies to Reduce Demand
    Potentially Better Practice

    4.2 Select the optimal care delivery method for patient needs

    Process Measure

    • # of non-face-to-face appointments

    Tools

    ACTT Virtual Appointment Guide Prenatal Care Case Study

  5. Optimize supply

    Potentially Better Practice

    5.1 Simplify appointment types and times and avoid carve-outs and other scheduling restrictions

    Process Measure

    • # of appointment types

    Tools

    Avoiding 'Carve-Outs'
    Potentially Better Practice

    5.2 Develop procedures to manage variation in supply and demand

    Process Measure

    • Third Next Available Appointment

    Tools

    Post Vacation Scheduling
    Potentially Better Practice

    5.3 Schedule patients to maximize continuity

    Process Measures

    • Internal continuity 

    Tools

    The Heirarchy of Booking
    Potentially Better Practice

    5.4 Synchronize elements of the appointment and optimize the clinic environment

    Process Measure

    • Cycle time # of interruptions

    Tools

    Cycle Time Tracker
    Potentially Better Practice

    5.5 Address factors contributing to no-show rate

    Process Measure

    • % of no-shows

    Tools

    Improving No-Shows

     

  6. Address Backlog

    Potentially Better Practice

    6.1 Assess backlog and develop a plan to address unplanned backlog

    Process Measure

    • # of backlogged appointments

    Tools

    Backlog Reduction Tool

  7. Coordinate care in the health neighbourhood

    POTENTIALLY BETTER PRACTICES

    7.1 Establish processes that facilitate effective transitions of care

    Process Measure

    • A process is documented for offering and managing follow up care

    Tools

    Home to Hospital to Home Change Package Collaborative Care Agreement
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