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 SummaryHigh Impact Changes
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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
Tools
Access to Continuity Infographic- Coming soon! Access literature summary
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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 - Review CII/CPAR portal:
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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 -
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
CMA Virtual Care Playbook ACTT Virtual Appointment Guide Prenatal Care Case Study -
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 Shaping Supply & Demand Case Study
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 Synchronization Tool Clinic Walk Through Tool
Potentially Better Practice
5.5 Address factors contributing to no-show rate
Process Measure
- % of no-shows
Tools
Improving No-Shows -
Address Backlog
Potentially Better Practice
6.1 Assess backlog and develop a plan to address unplanned backlog
Process Measure
- # of backlogged appointments
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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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