Timely access to care is one of the fundamental characteristics of a health system. Access to primary care is important since primary care both diagnoses and treats most common conditions and also acts as the gateway, in systems like VA, to other types of care.

Providing access to care is a struggle for almost all health systems. VA is committed to improving access to primary care without the need to add substantial additional resources. An earlier ESP review from 2011 focuses on interventions to improve Veterans access to care. Among the topics considered were opening new Community-based Outpatient clinics, integrating mental health care into primary care, expanding the use of telehealth, reducing co-payments, etcetera. VA has made some policy changes based on these findings. More recently, the Institute of Medicine released a report, commissioned by VA, entitled Transforming Health Care Scheduling and Access: Getting to Now. This report noted that, while timely access was likely a problem nationwide, there is a lack of evidence to provide setting-specific guidance on what constitutes timely care. Nevertheless, the report concluded that despite deficiencies there are enough data to conclude that several basic principles be followed to improve access to care: matching supply to demand, immediate engagement of patient's needs, patient preference on the timing and nature of care, need-tailored care, surge contingencies, and continuous assessment of changing circumstances.

Contents

• PREFACE
• ABSTRACT
  • INTRODUCTION
  • METHODS
  • RESULTS
  • CONCLUSION/DISCUSSION
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • TECHNICAL EXPERT PANEL
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1. What definitions and measures of intervention success are used, and what evidence supports use of these definitions and measures?
  • KEY QUESTION 2. What samples or populations of patients are studied, including eligibility criteria?
  • KEY QUESTION 3. What are the salient characteristics of local and organizational contexts studied?
  • KEY QUESTION 4. What are the key features of successful (and unsuccessful) interventions for organizational management of access?
  • KEY QUESTION 5. Are relevant, tested tools, toolkits, or other detailed material available from successful organizational interventions?
  • ADDITIONAL RELEVANT LITERATURE
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • RESEARCH GAPS/FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A. SEARCH STRATEGIES
• APPENDIX B. CRITERIA USED IN QUALITY ASSESSMENT
• APPENDIX C. PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX D. EVIDENCE TABLE
• APPENDIX E. CITATIONS OF FULL-TEXT EXCLUDES
• APPENDIX F. MEASUREMENT OF THIRD NEXT AVAILABLE

Suggested citation:

Miake-Lye IM, Mak S, Shanman R, Beroes JM, Shekelle PG. Access Management Improvement: A Systematic Review. VA ESP Project #05-226; 2017.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.