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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ejor.2006.10.003 Byline: Xiuli Qu (a), Ronald L. Rardin (a), Julie Ann S. Williams (b), Deanna R. Willis (c) Keywords: OR in health service; Appointment scheduling; Advanced access; No-show rate Abstract: Advanced access scheduling, introduced in the early 1990s, is reported to significantly improve the performance of outpatient clinics. The successful implementation of advanced access scheduling requires the match of daily healthcare provider capacity with patient demand. In this paper, for the first time a closed-form approach is presented to determine the optimal percentage of open-access appointments to match daily provider capacity to demand. This paper introduces the conditions for the optimal percentage of open-access appointments and the procedure to find the optimal percentage. Furthermore, the sensitivity of the optimal percentage of open-access appointments to provider capacity, no-show rates, and demand distribution is investigated. Our results demonstrate that the optimal percentage of open-access appointments mainly depends on the ratio of the average demand for open-access appointments to provider capacity and the ratio of the show-up rates for prescheduled and open-access appointments. Author Affiliation: (a) Purdue University, School of Industrial Engineering, 315 N. Grant Street, West Lafayette, IN 47907-2023, United States (b) University of West Florida, Department of Management and MIS, 11000 University Parkway, Bldg 76/128, Pensacola, FL 32514-5752, United States (c) Indiana University, Department of Family Medicine, 1110 W Michigan Street, Indianapolis, IN 46202, United States Article History: Received 17 December 2005; Accepted 25 October 2006

Abstract Background Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics. Methods A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient’s last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model. Results The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (p p Conclusions No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.

Academic underachievement, such as failing a class and the threat of being held back because of academic issues, is common. Family physicians can provide support and guidance for families as they approach their child's unique academic challenges. Specific learning disabilities are a group of learning disorders (e.g., dyscalculia, dysgraphia, dyslexia) that impede a child's ability to learn. Understanding standard educational terms; looking for medical, family, and social risk factors associated with academic underachievement; and investigating the medical differential for academic underachievement can help direct the family to appropriate care. The physician can provide medical documentation to support an individualized education program evaluation and address risk factors that schools may not be aware of or cannot assess. The family physician can support children and families by understanding the connection between risk factors, medical and educational evaluations, and educational resources. [ABSTRACT FROM AUTHOR]

Background and Objectives: The use of incentive compensation in academic family medicine has been a topic of interest for many years, yet little is known about the impact of these systems on individual faculty members. Better understanding is needed about the relationship of incentive compensation systems (ICSs) to ICS satisfaction, motivation, and retention among academic family medicine faculty.Methods: The Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) conducted a nationwide survey of its members in 2013. This study reports the results of the incentive compensation question subset of the larger omnibus survey.Results: The overall response rate was 53%. The majority (70% [360/511]) of academic faculty reported that they are eligible for some type of incentive compensation. The faculty reported moderate satisfaction, with only 38% being satisfied or highly satisfied with their ICS. Overall mean motivation and intent to remain in their current position were similar. The percentage of total income available as an incentive explained less than 10% of the variance of those outcomes. Faculty perceptions of appropriateness of the measures, understanding of the measurement and reward systems, and perception of due process are all related to satisfaction with the ICS, motivation, and retention.Conclusions: ICSs are common in academic family medicine, yet most faculty do not find them to motivate their choice of activities or promote staying in their current position. Design and implementation are both important in promoting faculty satisfaction with the ICS, motivation, and retention. [ABSTRACT FROM AUTHOR]

BACKGROUND: Practice-based learning and improvement (PBLI) has been promoted as a key component of competency-based training in medical student education, but little is known about its implementation. Methods: This project is part of a larger CERA omnibus survey of family medicine medical student clerkship directors carried out from July to September 2012. Analyses were conducted to as-sess clerkship infrastructure, learner assessment and feedback, and clerkship director perceptions of PBLI curricula. RESULTS: The majority (69.0%, 58/82) of family medicine clerk-ship directors reported that PBLI is not included in their clerkship. Significant predictors of PBLI in the curriculum include: regularly scheduled centralized teaching (weekly or more versus less than weekly, OR=1.14, 95% Cl=1.01-1.29) and clerkship director belief that students should achieve PBLI competency (agree in compe-tency versus disagree in competency, 0R=1.19, 95% Cl=1.08-1.30). Few (20.5%, 16/78) family medicine clerkship directors reported that the amount of PBLI in their curriculum is likely to increase in the next 12 months. The duration of the clerkship was a significant predictor of reported likelihood of increasing PBLI over the next 12 months (3 weeks versus 8 weeks, OR=1.23, 95% CI-1.00-1.51). CONCLUSIONS: Despite increased emphasis on quality improve-ment activities in practice, most family medicine clerkships do not currently offer PBLI curricula. Additionally, less than one in four family medicine clerkships plan on increasing the amount of PBLI curricula in the next 12 months. Continued research in this area is needed to identify successful models for PBLI curricular offerings. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this article is to describe our experience in implementing a primary care-based dementia and depression care program focused on providing collaborative care for dementia and late-life depression. Methods: Capitalizing on the substantial interest in the US on the patient-centered medical home concept, the Aging Brain Care Medical Home targets older adults with dementia and/or late-life depression in the primary care setting. We describe a structured set of activities that laid the foundation for a new partnership with the primary care practice and the lessons learned in implementing this new care model. We also provide a description of the core components of this innovative memory care program. Results: Findings from three recent randomized clinical trials provided the rationale and basic components for implementing the new memory care program. We used the reflective adaptive process as a relationship building framework that recognizes primary care practices as complex adaptive systems. This framework allows for local adaptation of the protocols and procedures developed in the clinical trials. Tailored care for individual patients is facilitated through a care manager working in collaboration with a primary care physician and supported by specialists in a memory care clinic as well as by information technology resources. Conclusions: We have successfully overcome many system-level barriers in implementing a collaborative care program for dementia and depression in primary care. Spontaneous adoption of new models of care is unlikely without specific attention to the complexities and resource constraints of health care systems. [ABSTRACT FROM AUTHOR]

The article reports on the refill program developed to manage controlled substance refill. It states that controlled substance refill is an unexpected event which leads to the discontinuity of care if not administered by patient's provider. It mentions that the refill program utilizes a recurring-calendar-event function in Microsoft Outlook or Lotus iNotes. Moreover, it says that randomizing toxicology screens is provided to determine the actual number of urine toxicology screen (UTS).

This article presents information on the relationship between patients and physicians. Patients sometimes escalate their behavior when they feel they aren't getting the services they expect or when they feel their needs aren't being addressed. Taking time to sit down with the patient with the goal of better understanding the underlying expectations or needs that are driving his or her behavior can be valuable. Some patients have unreasonable expectations, but for others, understanding the point they're trying to make can go a long way in repairing the relationship. Sometimes, no matter what one does, there is no hope of resurrecting the relationship.

The article focuses on the ways by which family physicians can improve the office efficiency. The key is to employ proven quality improvement techniques used throughout the business world to increase efficiency and quality while decreasing costs. For each process in the practice, such as checking in patients or making referrals, a series of steps must be accomplished correctly, in the right order and at the right time to produce the best outcome. Improving office flow requires everyone, from the front desk staff to the physicians, to be involved in the improvement process. Every office has the potential to achieve efficient flow throughout all of its processes. INSETS: SPEEDBAR;10 RULES FOR AN EFFICIENT PROCESS;KEY POINTS;CYCLE TIME

Gives advice on how to decide whether to buy a new medical equipment or not. Non-financial considerations of these investments; Pros and cons of making a capital investment on a medical equipment; Need to determine alternative investment opportunities that the practice have; Financial impact of making an investment on a medical equipment.

This article focuses on using bilingual staff members as interpreters. Caring for Hispanic patients who speak little or no English can be a challenge. Most bilingual staff members have not been trained to provide interpretation services. To help them fulfill this role, one should encourage them to seek training in this area. Using the universal form of the language is especially important when patients are from a different region or country than the staff member doing the interpreting. Introducing the interpreter to the patient prior to the medical encounter will give the interpreter an opportunity to explain his or her role. Doing so may also make the patient more comfortable.

A letter is presented in response to the article "A Proactive Approach to Controlled Substance Refills" by Jean Antonucci, Deanna R. Willis, Gerald Eaton, and Palmer MacKie in November/December 2010 issue along with the authors' response to the same.