Infant Well Child Care Appointment Models to Be Presented at PAS

Denver Health pediatrician Mary E. O'Connor, M.D., MPH, will present an abstract at the 2004 Pediatric Academic Societies' (PAS) annual meeting in May. O'Connor's study was one of 30 abstracts selected out of more than 2,000 to be presented that had outcomes worthy of high media scrutiny. She is the lead author of the study; Denver Health pediatrician Jeff Brown, M.D., and family health administrator, Bethany Matthews are co-authors.

O'Connor compared how Denver Health's new standard open access appointment system works to the traditional prescheduled appointments for infants' 2-, 4- and 6-month well child care (WCC) visits when vaccines were given. Appointment data was collected from a largely Hispanic patient population at one of Denver Health's neighborhood health centers, Westside Family Health Center. Most of the patients—82%—are Medicaid or Colorado Access (Medicaid managed care) recipients. Sixteen percent of those studied are Medicaid applicants.

The open access appointment model allows patients to call the week of, or one or two days in advance to schedule an appointment. Prescheduling appointments is the method used in most practices, where a patient makes his/her next appointment before leaving the physician's office, often for weeks or months in the future. This typically leads to high missed appointment rates and poor clinical efficiency.

Tracking 1,564 infant appointments over six months' time revealed the no"show rate using the new open access appointment system was significantly decreased from 21% in the old system, to 14% when appointments were scheduled two months ahead of time in the open access system (prescheduled), to 9% when they scheduled within a week using open access (standard).

"With our patient population, there are so many factors that need to be considered in order for the open access appointment system to be successful, " O'Connor said. "With open access, we were concerned if the mother did not call to make the appointment, the baby would miss an important appointment with the doctor and immunizations."

A goal of the open access system was to get the no-show rates to between 10—15%, or lower. In addition to open access decreasing no-show rates, O'Connor's study indicated that both prescheduled and standard open access scheduling improved on-time immunization rates. Only 27% of open access patients had delayed immunizations, while 40% of the infants before open access were delayed.

O'Connor's study also concluded that infants prescheduled in open access for their 2-, 4- and 6-month WCC had improved continuity of care compared to infants not prescheduled in an open access system. In a busy clinic setting, calling a day or two ahead of time for an appointment could not guarantee patients the doctor they prefer to see.

"We are very pleased that the open access system successfully decreased the no-show rate and decreased delayed immunizations," O'Connor said. "But due to the decreased continuity for our infants at Westside, we are continuing to preschedule 2-, 4- and 6-month WCC visits in an Open Access model."

Denver Health, formerly known as Denver General Hospital, is the Rocky Mountain Region's only Level 1 academic trauma center, and the safety net hospital for the Denver area. The Denver Health system, which integrates acute and emergency care with public and community health, includes the Rocky Mountain Regional Trauma Center, Denver's 911 emergency medical response system, Denver Health Paramedic Division, 9 family health centers, 10 school-based health clinics, the Rocky Mountain Poison and Drug Center, NurseLine, Correctional Care, Denver CARES, Denver Public Health, Denver Health Foundation and the Rocky Mountain Center for Medical Response to Terrorism, Mass Casualties and Epidemics.