title: Improving patient access to the Veterans Health Administration's primary care and specialty clinics.
abstract: BACKGROUND
  During the past four years the Veterans Health Administration (VHA) has been engaged in a national effort to improve access for patients to its 1,826 primary care, audiology, cardiology, eye care, orthopedics, and urology clinics by using the principles of open access or "advanced clinic access." The strategy entailed the development of successful cases to demonstrate the methods of advanced clinic access and provide evidence of its benefits for providers as well as patients in primary care and specialty clinics.
  
  
  RESULTS
  Four clinics--one primary care clinic and three specialty care clinics--showed dramatic improvement in waiting times for appointments (reductions range from 20 days in urology to 78 days in primary care).
  
  
  CONCLUSIONS
  Beyond the four case studies, hundreds of other clinics in the VHA are also applying advanced clinic access principles in their work. The diversity across the VHA suggests that the principles of advanced clinic access are robust across settings and types of clinics. However, the experience of other organizations with different structures and patient populations needs to be reported to fully demonstrate the generalizability of these results. Many of the changes were put in place during the project's final 18 months. Additional data will be needed to demonstrate sustained improvement.
authors.affiliation: Institute for Healthcare Improvement, Boston, USA. mschall@ix.netcom.com
authors.forename: Marie W
authors.initials: MW
authors.lastname: Schall
authors.forename: Terrence
authors.initials: T
authors.lastname: Duffy
authors.forename: Anil
authors.initials: A
authors.lastname: Krishnamurthy
authors.forename: Odette
authors.initials: O
authors.lastname: Levesque
authors.forename: Prashant
authors.initials: P
authors.lastname: Mehta
authors.forename: Mark
authors.initials: M
authors.lastname: Murray
authors.forename: Renee
authors.initials: R
authors.lastname: Parlier
authors.forename: Robert
authors.initials: R
authors.lastname: Petzel
authors.forename: John
authors.initials: J
authors.lastname: Sanderson
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D008511:Medicine / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D013038:Specialization; D017748:Time Management / Q000379:methods; D017749:Total Quality Management / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014850:Waiting Lists