title: A quality improvement intervention to increase access to pediatric subspecialty practice.
abstract: OBJECTIVE
  To improve access to new pediatric endocrinology appointments in an urban academic hospital faculty-based practice.
  
  
  METHODS
  Three strategies were implemented to increase the number of appointment slots: new patient appointments were protected from conversion to follow-up appointments; all physicians, including senior faculty, were scheduled to see 3 to 4 new patients per session; and sessions devoted exclusively to follow-up appointments were added based on demand. The main outcomes for this quality improvement activity were waiting times for new and follow-up appointments, monthly visit volume, the per-provider visit volume, differences in the proportion of new visits, and clinic arrival rates pre- and postintervention.
  
  
  RESULTS
  Thirteen months after the intervention, average wait for a new patient appointment decreased from 11.4 to 1.7 weeks (P < .001) and follow-up appointment wait time decreased from 8.2 to 2.9 weeks (P < .001). Mean monthly total visit volume increased from 284 to 366 patient visits (P < .01) and mean monthly visit volume per provider increased from 36.8 to 41.0 patients (P = .08). New patients were 27% of the visit volume and 35% after the intervention.
  
  
  CONCLUSIONS
  Access to our pediatric specialty care clinic was improved without increasing the number of providers by improved scheduling.
authors: Professor of Pediatrics and Medicine, Division Chief Pediatric Endocrinology and Diabetes, Albert Einstein College of Medicine, 3420 Bainbridge Ave, Bronx, NY 10467, USA. rheptull@montefiore.org
authors: Rubina A
authors: RA
authors: Heptulla
authors: Steven J
authors: SJ
authors: Choi
authors: Peter F
authors: PF
authors: Belamarich
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D001071:Appointments and Schedules; D002648:Child; D017598:Efficiency, Organizational; D004704:Endocrinology / Q000458:organization & administration*; D005180:Faculty, Medical / Q000458:organization & administration; D006284:Health Plan Implementation / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration*; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006786:Hospitals, Urban / Q000458:organization & administration*; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008511:Medicine / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010372:Pediatrics / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States; D014850:Waiting Lists