Improving access in a VA primary care clinic using an innovative Panel Retention Tool: a quality improvement report
- 10 June 2020
- journal article
- research article
- Published by BMJ in BMJ Quality & Safety
- Vol. 29 (11), 947-955
- https://doi.org/10.1136/bmjqs-2019-010398
Abstract
Background Loss to follow-up is an under-recognised problem in primary care. Continuity with a primary care provider improves morbidity and mortality in the Veterans Health Administration. We sought to reduce the percentage of patients lost to follow-up at the Northeast Ohio Veterans Affairs Healthcare System from October 2017 to March 2019. Methods The Panel Retention Tool (PRT) was developed and tested with primary care teams using multiple Plan, Do, Study and Act cycles to identify and schedule lost to follow-up patients. Baseline data on loss to follow-up, defined as the percentage of panelled patients not seen in primary care in the past year, was collected over 6 months during tool development. Outcomes were tracked from implementation through spread and sustainment (12 months) across 14 primary care clinics. Results Of the 96 170 panelled patients at the beginning of the study period, 2715 (2.8%) were found to be inactive and removed from provider panels, improving panel reliability. Among the remaining, 1856 (1.9%) patients without scheduled follow-up were scheduled for future care, and 1239 (1.3%) without recent prior care completed encounters during the study period. The percentage of patients lost to follow-up decreased from 10.1% (lower control limit (LCL) 9.8%–upper control limit (UCL) 10.4%) at baseline to 6.4% (LCL 6.2%–UCL 6.7%) postintervention and patients without planned future care decreased from 21.7% (LCL 21.3%–UCL 22.1%) to 17.1% (LCL 16.7%–UCL 17.5%). Conclusions The PRT allowed primary care teams in an integrated health system to identify and schedule lost to follow-up patients. Ease of use, adaptability and encouraging outcomes facilitated spread. This has the potential to contribute to more appropriate utilisation of healthcare resources and improved access to primary care.Keywords
This publication has 15 references indexed in Scilit:
- Validation of an automatically generated screening score for frailty: the care assessment need (CAN) scoreBMC Geriatrics, 2018
- Comparing Quality of Care in Veterans Affairs and Non-Veterans Affairs SettingsJournal of General Internal Medicine, 2018
- No-shows in appointment scheduling – a systematic literature reviewHealth Policy, 2018
- A Human-Centered Design Methodology to Enhance the Usability, Human Factors, and User Experience of Connected Health Systems: A Three-Phase MethodologyJMIR Human Factors, 2017
- Assessing factors for loss to follow-up of HIV infected patients in Guinea-BissauInfection, 2016
- The Veterans Affairs's Corporate Data WarehouseNursing Administration Quarterly, 2015
- Implementation of the Patient-Centered Medical Home in the Veterans Health AdministrationJAMA Internal Medicine, 2014
- The 10 Building Blocks of High-Performing Primary CareAnnals of Family Medicine, 2014
- Contribution of Primary Care to Health Systems and HealthThe Milbank Quarterly, 2005
- Are Patients at Veterans Affairs Medical Centers Sicker?Archives of Internal Medicine, 2000