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Clin Pediatr (Phila). 2010 Jul;49(7):664-70. doi: 10.1177/0009922810362577. Epub 2010 Mar 31.

"Dyading" in the pediatric clinic improves access to care.

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  • 1Denver Health, Denver, CO, USA, University of Colorado, School of Medicine, Denver, CO, USA. Mary.O'



This project evaluates the effect of "dyading" on pediatric outpatient care.


In "dyading," the medical assistant (MA) works with the provider in the exam room during the chart review, history taking, and patient education. In sequential care, the patient interacts with the MA, then the provider, then the MA again, with waiting in between. The authors measured visit time (from the MA starting with patient to the end of visit), the mean number of patients seen in a clinic session per provider, and patient satisfaction.


After implementation of "dyading," mean visit time decreased from 37 + or - 14 to 25 + or - 11 minutes, the mean number of visits/session increased from 8.24 to 9.25, and waiting in the exam room reported by families decreased from 77% to 46%.


"Dyading" decreased visit time, which increased the number of patients seen, thereby improving access to care. Patient time in the exam room decreased, which freed up exam rooms.

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