P1085 - Improving Access to Care in a Single-Provider Military Treatment Facility

Background:
Military Health System (MHS) beneficiaries have historically reported greater dissatisfaction with access to care than their civilian counterparts. At Osan Air Base in South Korea, the pediatric clinic of 1,200 patients is staffed by a single pediatrician, making improvements in access challenging. Command interest in increasing the number of command-sponsored children on base made improving access to care crucial.

Objective:
Our objective was to improve third-next-available future appointment booking time to 4.0 days and acute to 1.5 days without decreasing the average number of relative value units (RVUs) per week.

Methods:
We conducted plan-do-study-act (PDSA) cycles aimed at increasing access to care for future and acute visits. Baseline pre-intervention data was obtained via chart reviews of medical records from August to September 2019. We based initial clinical interventions on RESET for Pediatrics developed by Fairchild AB Pediatrics, including turning off cross-booking and scrubbing appointments. Subsequent interventions included switching acutes to the afternoon, offering virtual visits, and changing the future/acute appointment ratio to 70/30 from 60/40. We implemented these interventions in four PDSA cycles and followed third-next-available dates in clinic from October 2019 to February 2020. To analyze the benefit of improved access, we noted changes in patient satisfaction and tracked RVUs earned per week.

Results:
The baseline third-next-available appointment was an average of 10.7 days for future and 2.9 days for acute appointments. After the full intervention period, the third-next-available future appointment had decreased to 4.0 days for future and 1.1 for acute visits. Third-next-available decreased in a step-wise fashion with each intervention until January, when the provider was out of clinic for two weeks, but continued to decline in February.
Average number of RVUs per week pre- and post-intervention were not significantly different, at 19.45±3.95 and 19.01±0.91, respectively. Patient satisfaction with ease of making an appointment increased from 68.9% pre-intervention to 87.6% post-intervention.

CONCLUSIONS
The interventions improved access in our single-provider clinic and the goal for third-next-available future and acute appointments was met in December 2019 and February 2020, respectively. Both measures increased significantly in January, when the provider was out for two weeks, but quickly continued to decline in February. The number of RVUs per week was maintained despite opening up access significantly in clinic and switching many appointments to virtuals. Patient satisfaction increased significantly during the study period.
Limitations on this data include that 132 patients were redistributed to family medicine in October; however, the proportional decrease in empaneled patients was small compared to the significant decreases in third-next-available appointment times. Additionally, the post-intervention data was only collected until February due to the COVID-19 outbreak in March.
This data indicates that in access to care can be improved significantly in single-provider clinic without decreasing reimbursement.