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Managing access to primary care clinics using scheduling templates

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Abstract

An important challenge confronting healthcare is the effective management of access to primary care. Appointment scheduling policies/templates can help strike an effective balance between the lead-time to an appointment (a.k.a. indirect waiting time, measuring the difference between a patient’s desired and actual appointment dates) and waiting times at the clinic on the day of the appointment (a.k.a. direct waiting time). We propose methods for identifying effective appointment scheduling templates using a two-stage stochastic mixed-integer linear program model. The model embeds simulation for accurate evaluation of direct waiting times and uses sample average approximation method for computational efficiency. The model accounts for patients’ no-show behaviors, provider availability, overbooking, demand uncertainty, and overtime constraints. The model allows the scheduling templates to be potentially updated at regular intervals while minimizing the patient expected waiting times and balancing provider utilization. Proposed methods are validated using data from the U.S. Department of Veterans Affairs (VA) primary care clinics.

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Acknowledgements

We thank the U.S. Veteran’s Health Administration for sponsoring part of this research.

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Authors and Affiliations

  1. WarnerMedia, 1050 Techwood Dr NW, Atlanta, GA, 30318, USA

    Sina Faridimehr

  2. Department of Industrial and Systems Engineering, Wayne State University, Detroit, MI, 48201, USA

    Saravanan Venkatachalam & Ratna Babu Chinnam

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  1. Sina Faridimehr
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  2. Saravanan Venkatachalam
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  3. Ratna Babu Chinnam
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Correspondence to Saravanan Venkatachalam.

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Appendix A

Appendix A

In this section, we provide a step-by-step example of the two-stage stochastic optimization approach for appointment scheduling in an outpatient clinic. Figure 19 represents a step-by-step example of our optimization approach for appointment scheduling. In this example, we assume that there are two working days per week each having two sessions (morning and afternoon) and four appointment slots per day. There are three patient types: Acute (A), Chronic (C), and Preventive (P). We use the parameters of base case study such as: threshold for patient direct waiting time (≤ 30 minutes); threshold for provider over time work spillover from morning session into lunch hour (≤ 45 minutes); threshold for provider over time work after second session of the day (≤ 60 minutes). The patients that are already scheduled are shown in red and patients that can be scheduled are shown in purple. For example in iteration 1, one acute patient is already scheduled in slot 1 of day 1 and one preventive patient is already scheduled in slot 6 of day 2. For simplicity, we only show first-stage of two-stage stochastic optimization in iterations 2 and 5.

Fig. 19
figure 19

Illustration of scheduling template optimization approach

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We added a step-by-step example in the appendix to demonstrate the details of the index policy as shown in Fig. 20.

Fig. 20
figure 20

Illustration of the use of Index Policy in combination with the scheduling template by the call center to schedule patients

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Faridimehr, S., Venkatachalam, S. & Chinnam, R.B. Managing access to primary care clinics using scheduling templates. Health Care Manag Sci 24, 482–498 (2021). https://doi.org/10.1007/s10729-020-09535-z

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  • DOI: https://doi.org/10.1007/s10729-020-09535-z

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