Improving access to a community health center's podiatric specialty clinic: A quality improvement project with a clinical microsystems approach

Community health centers (CHCs) are designed to reduce disparities affecting minority groups, poor and uninsured Americans, provide a safety net of support and play a prominent role in providing care for disadvantaged populations. CHCs are the medical home for approximately 5% of the current US population and deliver care to nearly 20 million people. As Medicaid expands and health insurance exchanges are established, the percentage of Americans utilizing CHC services will grow. Many are concerned that the capacity of CHCs to care for patients beyond primary care will be inadequate. With the increase in CHC patronage, the need for subspecialty care will also increase. The patient wait time for completion of a podiatric specialty referral in a community health center was identified as a specialty care access challenge and a quality improvement project using a clinical microsystems approach was performed in an attempt to improve access to the podiatric specialty clinic. An in depth evaluation of this health services process was undertaken. Statistical process analysis for podiatric referral wait time was performed, followed by the presentation of recommendations to reduce long wait times for patients referred to this community health center's podiatric specialty clinic.