DM White-Taylor, PhD, GV (Sonny) Montgomery VA Medical Center

Objectives: Jackson VAMC has been successful in implementing several strategies to improve access to care. The following examples demonstrate the collective efforts and changes that occurred to improve access to care for all patient populations particularly patients enrolled in Primary Care.

Methods: Target access areas identified were: point of entry into the system, telephone communication, waiting time, appropriate level of care, and timeliness of receiving appropriate care. Interdisciplinary teams using the continuous quality improvement model (Plan, Do, Study, Act) developed structures, new processes, and identified performance measures to show effectiveness.

Improvement to care at the point of entry, the following actions were taken: Clinic space renovated, improved method of assigning patients to one provider, improved process for patient orientation regarding his/her assigned provider and how to access care, appointment scheduling, and movement of support services closer to Primary Care (EKG, X-Ray).

Reduction in the telephone abandonment rate, the following actions were taken: Use of an distribution monitor for automated caller, development of telephone treatment protocols, distribution of telephone protocols throughout the medical center (inpatient and outpatient, including all clinics primary care and sub-specialty and all bed service sections), and assignment of all personnel to one supervisor.

Inappropriate visits to Urgent Care were reduced and the average waiting time decreased, and the following actions were taken: Analysis of patient needs indicated that the majority of patients did not need emergency room care and were not being prioritized according to needs. A registered nurse was included in the check in process to complete a brief assessment.

The timeliness of patients receiving appropriate care was improved, the following actions were taken: Development of a patient oriented screening form (patient self-assessment), along with staff education, and written instructions for implementation and documentation. Electronic clinical reminders were developed and implemented via VISTA patient care encounter program (PCE software package). These reminders have been replaced with clinical reminders in Computerized Patient Record System (CPRS).

Results: Reduction in Primary Care cycle time from 199 minutes to 80 minutes; reduction in triage walk-in time from an average of 5 1/2 hours to an average of 45 minutes; the number of inappropriate visits to urgent care decreased from approximately 80% to 18%; telephone advice abandonment rate decreased from 51 % to 4.9 %; improved timeliness of annual prostate screening from 42 % to 95%; and improvement in the timeliness of alcohol screening improved from 30% to 100%. Additionally, Jackson VAMC can demonstrate " Best in Practice" within the VHA. For example, alcohol screening for Jackson was 100% compliant and VHA was 63%.

Conclusions: Jackson VAMC has been successful in meeting access to care needs of Veterans at several areas of contact. The success in improving patient care was through the use of: a) a data driven system; b) interdisciplinary self-directed teams; c) involving staff; and d) patient and first line employee empowerment through shared decision making.

Impact: These processes can be duplicated throughout Network 16 and VHA to improve access to care for all patient populations.