Managing access to primary care clinics using scheduling templates

Abstract

An important challenge confronting healthcare is the effective management of access to primary care. Appointment scheduling policies/templates can help strike an effective balance between the lead-time to an appointment (a.k.a. indirect waiting time, measuring the difference between a patient's desired and actual appointment dates) and waiting times at the clinic on the day of the appointment (a.k.a. direct waiting time). We propose methods for identifying effective appointment scheduling templates using a two-stage stochastic mixed-integer linear program model. The model embeds simulation for accurate evaluation of direct waiting times and uses sample average approximation method for computational efficiency. The model accounts for patients' no-show behaviors, provider availability, overbooking, demand uncertainty, and overtime constraints. The model allows the scheduling templates to be potentially updated at regular intervals while minimizing the patient expected waiting times and balancing provider utilization. Proposed methods are validated using data from the U.S. Department of Veterans Affairs (VA) primary care clinics.

Keywords: Appointment scheduling; Direct waiting; Indirect waiting; Operations research; Patient no-show; Sample average approximation; Simulation; Stochastic programming; Two-stage model.