Higher Percentage of Virtual Primary Care Associated With Minimal Differences in Achievement of Quality Metrics.

Objective: To test the impact of virtual care usage on quality metrics used for performance measurement.

Background: Virtual care improves access to primary care; however, the quality of care must not be adversely impacted by its use.

Methods: This is a mixed-design etiologic study using data from patients receiving primary care in a large, regional health system from January 2020 through December 2021.

Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA.

Objectives: Through analysis of claims and payment data, we quantified several implications of shifting ancillary healthcare services from regulated, more expensive to unregulated, less expensive sites. We also quantified the implications of this shift on access to services, with a focus on differences in access between rural and urban patients for a Medicaid (disadvantaged) population in Maryland, USA.

Design: Using a dataset of all Medicaid claims records for 1 year, we identified and extracted all bundles of regulated and unregulated ancillary services.

Managing prior approval for site-of-service referrals: an algorithmic approach.

Objectives: Many payers and health care providers are either currently using or considering use of prior authorization schemes to redirect patient care away from hospital outpatient departments toward free-standing ambulatory surgical centers owing to the payment differential between these facilities. In this work we work with a medium size payer to develop and lay out a process for analysis of claims data that allows payers to conservatively estimate potential savings from such policies based on their specific case mix and provider network.

Study Design: We analyzed payment information for a medium-sized managed care organization to identify movable cases that can reduce costs, estimate potential savings, and recommend implementation policy alternatives.

Using a real-time location system to measure patient flow in a radiation oncology outpatient clinic.

Purpose: Common performance metrics for outpatient clinics define the time between patient arrival and entry into an examination room as "waiting time." Time spent in the room is considered processing time. This characterization systematically ignores time spent in the examination room waiting for service.

Changes to physician processing times in response to clinic congestion and patient punctuality: a retrospective study.

Objectives: We examine interactions among 3 factors that affect patient waits and use of overtime in outpatient clinics: clinic congestion, patient punctuality and physician processing rates. We hypothesise that the first 2 factors affect physician processing rates, and this adaptive physician behaviour serves to reduce waiting times and the use of overtime.

Setting: 2 urban academic clinics and an affiliated suburban clinic in metropolitan Baltimore, Maryland, USA.

Applying JIT principles to resident education to reduce patient delays: a pilot study in an academic medical center pain clinic.

Objectives: This study investigated the effect on patient waiting times, patient/doctor contact times, flow times, and session completion times of having medical trainees and attending physicians review cases before the clinic session. The major hypothesis was that review of cases prior to clinic hours would reduce waiting times, flow times, and use of overtime, without reducing patient/doctor contact time.

Design: Prospective quality improvement.

Patient punctuality and clinic performance: observations from an academic-based private practice pain centre: a prospective quality improvement study.

Objectives: The aim of this study was to examine the effects of an intervention to alter patient unpunctuality. The major hypothesis was that the intervention will change the distribution of patient unpunctuality by decreasing patient tardiness and increasing patient earliness.

Design: Prospective Quality Improvement.

Using process analysis to assess the impact of medical education on the delivery of pain services: a natural experiment.

Background: The medical, social, and economic effects of the teaching mission on delivery of care at an academic medical center (AMC) are not fully understood. When a free-standing private practice ambulatory clinic with no teaching mission was merged into an AMC, a natural experiment was created. The authors compared process measures across the two settings to observe the differences in system performance introduced by the added steps and resources of the AMC's teaching mission.