Advanced Access: Implementation and Outcomes in an Urban Community Health Center

TARGET POPULATION:

Of all the Unity Health Care, Inc.'s community health centers, Upper Cardozo Health Center (UCHC) is the largest and most diverse, with a patient enrollment of over 17,000 (1/3 less than 18 years old) and with annual visits greater than 76,000 in 2007. Of UCHC's users, 65% are Latino, 20% African Americans, and 12% other. UCHC's primary care department is staffed by multi-disciplinary primary care providers.

METHODS: The advanced access model was implemented between April-December 2007 for its primary care department. In UCHC's advanced access model, the patient calls 24 hours in advance to schedule an appointment with his/her provider. Future appointments scheduled beyond 24 hours are limited to users with language barriers, transportation barriers, phone access barriers, or need for close follow-up. The six month planning phase included assessment of the center's infrastructure, development of a recall system, and collection of baseline metrics. Metrics included “no show” rate, primary care continuity, utilization, and supply and demand capacity.

RESULTS: The most dramatic and immediate result was a 50% reduction in “no show” over a period of 8 months from 30% to 15%. Primary care continuity of care in 2007 was 71% in the first quarter, 78% in the second quarter, 48% in the 3rd quarter, and 55% in the 4th quarter 2007. Utilization increased from 86% to 89%. The percentage of patients satisfied with their experience with the clinic and wait times (as good to excellent) remained mixed with 84% in the first quarter, 54% in the second quarter, 83% in the 3rd quarter, and 65% in the 4th quarter.

CONCLUSION: The supply/demand mismatch represents a major limitation to improve patient satisfaction and primary care continuity. Current demand continues to exceed supply of available appointments. However, in our previous model of delivery, there was comparable patient dissatisfaction due to the long wait times for an appointment, often exceeding 30 days for a new patient. Our experience and the tracking data suggest that much improvement has been made -- particularly with “no show” reduction, increased utilization, and improved patient satisfaction for those who obtained appointments. However, challenges remain in meeting patient demand with current provider supply. Despite the financial limitations of a community health center, difficulty of data collection, and increasing numbers of uninsured and underinsured patients, UCHC's advanced access model strives to improve the quality of care to an underserved, low-income, and immigrant population in inner city Washington DC.