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Improving Access to Care and Efficiency: Patient-Centered Methods and Strategies

Research Topic(s): Population Health / Systems Engineering / Information Science

Personnel: Bradley Doebbeling, MD, MSc, Tammy Toscos, PhD, Kislaya Kunjan PhD (ABD), Ayten Turkcan, PhD


Our interdisciplinary panel of informaticists and systems engineers, with clinical, methodologic, workflow and implementation research expertise, will present findings from a large, multisite systems redesign and implementation research project to improve access to care and efficiency in 40 community health centers (CHCs). The project employs innovative workflow assessment strategies, simulation modeling, data analytics and implementation research to uncover effective approaches to redesign CHCs for improved efficiency and access to care. Two of the key intervention strategies to improve efficiency and access to care uncovered in the study are: 1) engagement of patients, providers and staff in designing and implementing a culture of accountability and customer service; and 2) the optimization and implementation of expanded open access appointment scheduling. Learning objectives include: 1) Demonstrate the value of a conceptual framework from complexity science, positive deviance, in driving study design and implementation methods; 2) Familiarize the audience with patient-centered, workflow assessment, intervention prioritization strategies, community health data warehousing, role-specific dashboards, and implementation science methods likely useful in a broad range of clinical settings; 3) Discuss next steps in the use of the data warehouse, dissemination and spread, and follow-up studies.

Importance of Topic:

The Institute of Medicine (IOM) defines high quality healthcare as one that is: safe, effective, patient-centered, efficient, equitable, and timely. Widespread issues exist in the quality of healthcare in the United States and access to care in particular continues to face challenges. Access to care means gaining entry into and the use of healthcare, which in turn necessitates a fit between the patient and healthcare system in terms of availability, accessibility, accommodation, affordability and acceptability. Poor access negatively impact patients, families as well as providers in terms of health outcomes, patient satisfaction with care, organizational reputation, healthcare utilization and efficiencies. Multiple factors contribute to this problem with access. While financial and insurance barriers are significant contributors to poor access, there are challenges stemming from inadequate capabilities in patient appointment scheduling and workflow management. Optimizing appointment scheduling systems have assumed great significance in light of recent healthcare legislations, notably the Affordable Care Act that contains comprehensive health insurance reforms and the push for health centers to achieve Patient-Centered Medical Home (PCMH) recognition, which places strong emphasis on patient-centeredness, patient experience of care and reinforces incentives for meaningful use of health information technology. Not surprisingly, the very first standard within PCMH is to ‘Enhance Access and Continuity’.

Community health centers (CHCs) play a pivotal role in access to and delivery of primary healthcare to the underserved population. We have been conducting a 3 year multisite, access to care collaborative study of 7 community health center systems in Indiana (representing 40 different sites), funded by the PCORI (Patient Centered Outcomes Research Initiative). This topic is timely, urgent and needed because of the prevalence, cost and impact of access to care problems in the US. Specific patient-centered strategies discussed in this study may be used to redesign health systems to improve access to care, timeliness and costs in a broad range of health settings.

Potential Audiences:

We expect these findings to be of broad interest to clinical informaticists, health care systems leaders, clinicians, managers and policy makers as they seek to improve access to care and efficiency, and implement new information and scheduling systems in their own health systems.

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