Access to care remains a problem in the U.S because scheduling is based on providers' convenience, and practices fail to properly use nurse practitioners and physician assistants, according to an Institute of Medicine report.
The report, titled Transforming Health Care Scheduling and Access: Getting to Now, follows up on the IOM's landmark 2001 report, Crossing the Quality Chasm, which identified six properties of high-quality healthcare: safety, effectiveness, patient-centeredness, efficiency, equity and timeliness. Of those six, according to the new report, timeliness is probably the least studied and understood.
The report was partially funded by the Veterans Affairs Department and was prompted by the recent scandal at VA facilities in Phoenix, where 40 veterans died while waiting for an appointment. While their deaths were not necessarily caused by their inability to get healthcare, the IOM report cites studies showing how delays in care can have severe consequences for patients with cancer, diabetes, joint problems, kidney disease, and mental and substance-abuse issues.
The 137-page report includes 15 pages of citations of available research on the issue of access and wait times at facilities from multiple specialties and geographic regions that have developed best practices on this issue. These include: Dana-Farber/Brigham and Women's Cancer Center in Boston, Cincinnati Children's Hospital and the Southcentral Foundation's Alaska Native Medical Center in Anchorage. It also looked at manufacturing work-flow processes such as the Toyota Production System and the airline industry's Crew Resource Management system. And It touched on how Amazon.com and Netflix use data-mining to produce a better customer experience.
The report also cited October 2014 data that showed how wait times for new primary-care patients at VA facilities averaged 43 days and varied from two to 122 days across the system. The report also cites a 2014 study by the Merritt Hawkins physician-recruitment firm that found that patients in Massachusetts waited an average of 50 days to see an internist and 39 days to see a family-medicine physician.
“The healthcare system currently reflects mainly the priorities of providers and organizations, which has resulted in a focus on traditional scheduling systems that have not been engineered to engage or satisfy patients, but that instead are designed to fit a staff schedule that may be poorly aligned with patient perspectives or circumstances,” the report stated.