1. Open Access Appointment Scheduling: Impact on Physicians & Patients Mark Linzer, MD Linda Baier Manwell, MS Roger Brown, PhD James Bobula, PhD Eric Williams, PhD University of Wisconsin-Madison & University of Alabama-Tuscaloosa

2. Background on Open Access Developed to improve patient access to care Shown to improve: Missed appts for well-child visits & on-time immunizations (O’Connor, 2006) Operational efficiency (Parente, 2005; O’Hare, 2004) Days between appt scheduling/being seen by an MD (Parente, 2005; O’Hare, 2004) Continuity with primary MD (Parente, 2005; O’Hare, 2004) Increased MD compensation (O’Hare, 2004)

3. Background on Open Access Conflicting evidence for patient satisfaction: No significant difference in patient satisfaction (Parente, 2005) Improved patient satisfaction (O’Hare, 2004) Theoretically, open access will increase MD stress while working off the backlog; stress and satisfaction will improve thereafter.

4. Aims To assess the impact of open access on MD stress and satisfaction To assess the impact of open access on patient satisfaction

5. MEMO Study Longitudinal, observational study of 422 general internists and family physicians 97 clinics in 5 regions: New York City, Chicago, Milwaukee area, Madison area, and rural/small town Wisconsin Impact of the healthcare work environment on quality of care and role of physicians as mediators of this effect 1795 patients with hypertension, diabetes and/or CHF

6. MEMO Conceptual Model Workplace Characteristics Structure Culture Workflow Policies, processes Patient demands Patient satisfaction Quality of care Medical errors Burnout Mental health issues MD Stress MD Satisfaction

7. MEMO Measures Physician survey Work environment Mental health Job satisfaction Open access appointment scheduling (y/n) Patient survey Satisfaction with physician Satisfaction with clinic Trust in physician

8. Work-induced stress Time pressure Work control: e.g. Deciding when to admit patients to the hospital Details of clinic schedule Hours worked Work interruptions Patient load Work pace Intent to leave within 2 years Job satisfaction MEMO Measures

9. 422 primary care physicians (84.4% of target 500) 59.2% of those surveyed responded 51% GIM 49% FP 44% female 83% white 83% full-time Age 44 (range 29-89) Physician Participants

10. Results: Open Access 62 physicians stated they had open access 48% GIM 52% FP 113 physicians did not have open access 247 either didn’t specify, or physicians within the clinic didn’t agree Duration of open access: 1-60 months mean = 18 months (SD=13.22)

11. Results: MD Outcomes in Open Access Clinics Lower MD stress in open access clinics (p<.05) Less time pressure in open access clinics (p<.05) More work control in open access clinics p<.05) Less intent to leave in open access clinics p<.05) Similar job satisfaction among all MDs

12. Of 788 patients with chronic conditions: 246 from open access clinics 542 not from open access clinics  Similar rates of satisfaction with the MD  Similar rates of satisfaction with the clinic  Similar rates of trust in the MD Results: Patient Outcomes

13. Impact of Duration of Open Access After controlling for MD age, gender, and other predictors of MD stress and job satisfaction... The relationship between amount of time in open access and physician stress and satisfaction were negligible The favorable impact of simply being in an open access clinic on MD stress and stressors was maintained

14. Next Steps Determine the impact of open access on other patient outcomes: Disease control Medical errors Preventive care

15. Limitations 50% of physicians did not specify if open access available in their clinics Open access has evolved in some cases into “advanced access” (different structure) Only 5 regions included (NYC and upper Midwest) Self-reported data

16. Conclusions Open access is beneficial to physician worklife Open access has little impact on satisfaction for patients with chronic conditions Further analysis is necessary to determine the impact of open access on other patient outcomes

17. Consultants Eric Williams Bob Konrad Elianne Riska Bill Scheckler Stewart Babbott JudyAnn Bigby Peggy Leatt Said Ibrahim Jacqueline Wiltshire MEMO Staff Jim Bobula Marlon Mundt Roger Brown Carolyn Egan Chicago Region Anita Varkey Bernice Man Elizabeth Arce Milwaukee Region Ann Maguire Barb Horner-Ibler Laura Paluch Rural/Small Town WI Mary Beth Plane John Frey Jessica Grettie Mary Lamon-Smith Madison Region Julia McMurray Jessica Sherrieb James Gesicki New York Region Mark Schwartz Joe Rabatin Karla Felix Debby Dowell MEMO Team