Gauging patience among patients: Integrating qualitative and quantitative measures to determine wait-day thresholds at which patients in a large urban Medicaid health plan, judge delays in access to be excessive

Health care reform has made timely access an increasingly pressing quality metric (more patients, finite doctors).  CAHPS surveys give the widest-used measures of access delay from patients’ perspectives.  Due to their nature and purpose, the questions are subjective, along these lines: “How often did you get care as soon as you needed?  (Never, Sometimes, Usually, Always).”  Patients’ differences in the meaning of “as-soon-as-you-needed” pose a challenge for root cause analysis in quality improvement.

(1) Analytic objective: This paper provides a statistical answer to that semantic problem.  By comparing numeric measures of wait time against those subjective measures, we calculate non-subjective thresholds (actual days of delay) associated with those four subjectively-determined response terms, to reveal respondents’ standards for timely care.

(2) Data: The study is set in a large urban Medicaid health plan in a populous and ethnically diverse county in the  southwestern United States.  The study uses patients’ self-reported recall data on access delays, from CAHPS surveys in 2011 (n=16,288) and related studies.

(3) Practical uses: Expressed numerically as days-of-wait, assessing whether patients’ expectations are clinically reasonable or not becomes feasible: Knowing patients’ expectations provides context for health education messaging.  Knowing how many days of delay triggers negative ratings by patients, gives administrators a way to calculate the costs of reducing delays toward patient’s expectations: (a) serving patients better, and (b) receiving better accreditation scores and Medicare revenue for improved service.  Other implications are discussed: demographic groups’ differences in assessing delay; impact on missed visits; impact on inappropriate ER use.