269498 Patients and patience: The impact of delays on avoidance of preventive care -- CAHPS findings in a large urban Medicaid health plan, 2008-2011

Tuesday, October 30, 2012

S. Rae Starr, MPhil, MOrgBehav , HealthCare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Timeliness of care is a key component in effective and high quality care. Delays are a known concern with acute illness -- but the less visible problem is the missed visits for tests and preventive care to identify diseases that shorten life and well-being. As more patients access health care, delay will become an increasingly prominent health care concern.

Health care administrators have various tools for monitoring delays in care. Regulators and accreditation organizations require health plans to track the number of doctors in their networks, and assess accessibility by ratios of doctors and patients assigned to them. Much less is known about the duration of delays experienced by patients seeking appointments -- or the impact of those delays on the decision of a patient to not seek routine care.

(1) Setting: This presentation reports the timeliness or delay in access for patients in a large urban Medicaid health plan, using CAHPS (2008-2011).

(2) A question of perspective: CAHPS frames appointment delays in subjective terms: How often did patients receive care as soon as they felt they should? A common rejoinder by harried clinicians is that (a) patients have unrealistic expectations about how quickly care should be available; and (b) patients have imperfect recall about wait days. Are patient assessments reliable?

(3) Refining timely access measures on CAHPS: Member recall can be used to assess clinic self-studies of wait time. This requires adding particular questions to CAHPS: (a) asking members actual wait days, rather than asking about expectations; and (b) distinguishing between care received from primary care physicians and specialists. The resulting questions permit targeting the findings for intervention in specific settings (primary care vs specialist clinics) and populations (adult vs pediatric).

(4) Analyses: Findings from CAHPS will be used to examine four types of questions. (a) How long does the average Medicaid member wait to get care? How common and attainable is same-day service? How common are extremely long delays? (b) Impacts: Where do access delays rank among member-reported barriers to getting recommended checkups? (c) Vulnerabilities: How long do children wait versus adults in getting Medicaid-covered services? (d) How do member expectations compare against prevailing regulatory standards on speed of access? (e) How do access delays impact patient assessments of health care quality?

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Social and behavioral sciences

Learning Objectives:
1. Describe how appointment delays rank as barriers to patients getting recommended checkups. 2. Evaluate how timeliness of care impacts patient assessments of health care quality. 3. Define strategies for addressing barriers to timely access. 4. Compare the delays reported by adults versus parents of children for Medicaid-covered services. 5. Discuss methods for validating provider network access and availability measures, using CAHPS and other measures. 6. Describe how patient-reported appointment wait days compare with clinic-reported delays in access.

Keywords: Access and Services, Barriers to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Served six years as Senior Biostatistician at the largest public health plan in the United States, serving Medicaid and CHIP populations in an ethnically diverse urban county in the southwest United States. Managed CAHPS survey from 2006 to 2012 to obtain actionable information to guide the design of interventions to improve the quality of services and care. Designed supplemental questions for CAHPS to capture patients' calendar waiting time for appointments.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.