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Qual Manag Health Care. 2008 Oct-Dec;17(4):320-9. doi: 10.1097/01.QMH.0000338553.13136.57.

Improving access to pediatric subspecialty care: initial failures and lessons learned.

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Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.



We originally examined the effectiveness of strategies, proven successful in improving appointment availability in primary care, at a large tertiary-care academic medical center. We then sought to describe the reasons for the initial failure of these strategies.


Clinics participating in an access improvement initiative were matched to control clinics. Intervention clinics used a variety of techniques to improve access. Run charts were used to determine the impact of the interventions on appointment availability. Linear models, control charts, and other graphic displays were used to understand the relationship among supply, demand, and appointment availability.


Access did not improve in intervention clinics. Neither a linear models approach nor the use of control charts resulted in a simple tool to help clinics better understand the relationship among supply, demand, and days to third next available appointment. However, the development of a single clinic chart that incorporated supply and demand, plus estimates of future supply and demand, made it clear that current supply would not be able to meet demand. This helped teams focus their efforts on improving supply.


Use of detailed data-based tools to guide choices of interventions, coupled with new and explicit institutional expectations for physician attendance at clinics, appears to be a promising strategy for enhancing access.

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