Background/Purpose:

Open access clinics have been studied extensively in the primary care setting ¹, but there is limited data regarding rheumatology open access clinics. To improve rheumatology clinic access for patients, we created a same day clinic. We anticipated an improvement in access, no show rates, and a unique learning opportunity for fellows to see more acute rheumatologic conditions than in conventional academic clinic practice.

Methods:

A rheumatology fellow-based same day clinic (SDC) was created at a tertiary care academic health center. Clinic appointments were made available forty-eight hours before the appointment using an electronic scheduling system, or through a call center. Patients could also contact their PCP to refer them electronically. Same day appointments are available five days a week at one of four clinics staffed by the division of rheumatology at Henry Ford Hospital. Second year fellows were assigned to SDC, supervised by a senior staff attending, who were on call and exempted from routine clinics. To gauge improvement in access, we compared the time to third next available appointment for both follow up and new patients, before and after SDC implementation. Press-Ganey patient satisfaction surveys were used to evaluate patient satisfaction. We also compared the no-show rates in clinic before and after SDC implementation. Educational value for the fellows was assessed by a focused questionnaire.

Results:

Implementation of same day clinics improved access with a decreased time to third next available appointment from 30.9 days in June, 2014, to 20.8 days in March, 2015. Although the overall patient satisfaction score did not change; measures including the access score and the ability to get the desired appointment improved from 81.9 to 87.5, and 78.8 to 90 respectively from July, 2014, to February, 2015. The no show rate remained unchanged, and it was specifically high in February, 2015, due to brutal winter weather in Michigan, and implementation of new insurance market exchanges. The fellows reported enhanced educational value from exposure to patients with acute, non-emergent complaints. Many new consults seen by the fellows in SDC were followed in their respective continuity clinics, although many patients did not require a second visit.

Conclusion:

Implementation of a same day clinic (SDC) in an academic rheumatology practice improved access, access score, and the ability to get a desired appointment. We did not see improvement in overall patient satisfaction scores or no show rates. Further improvement and refinement is anticipated as we expand this SDC model to our other rheumatology clinic sites across several counties. A preliminary survey of the current fellows showed positive educational benefits, and as the model expands to more clinic locations in the future, we anticipate statistical improvement that can be measurable and actionable. In addition, SDC could provide some financial benefit for health care system by minimizing the number of unnecessary ER visits and hospital admissions.

1. Katherine D. Rose, MD; Joseph S. Ross, MD, MHS; Leora I. Horwitz, MD, MHS. Advanced Access Scheduling Outcomes. A Systematic Review. Arch Intern Med. 2011;171(13):1150-1159.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/same-day-rheumatology-access-clinic-in-an-academic-health-care-center/