JOURNAL TRANSCRIPT

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Operational Definition MEASUREMENT: 3rd Next Available Appointment I. Description and Rationale This measure answers the question: How long do patients have to wait for a new visit appointment to a specialty or primary care outpatient clinic? 3rd Next Available Appointment is a core business measure for outpatient access. It is measured as the length of time in calendar days between the day a patient makes a call for an appointment with a clinical care provider and the third available appointment. This measure does not restrict to a certain campus or provider since it measures availability regardless of particular patient preferences. Access is tracked for new patients because a primary concern of the CCHMC patient advisory group is our ability to get patients into the system for their first appointment in a timely manner. It measures the effect of changes in the overall scheduling system and not our responsiveness to a single patient who needs to be seen quickly. For this reason, the 3rd Next Available is preferable to the first or second. It has been shown in other settings to be a better reflection of system availability because often first and second available appointments are due to cancellations, “working patients into the schedule”, or other events. II. Population Definition (Inclusions/Exclusions) All outpatient clinical divisions within the Department of Pediatrics, Department of Surgical Services, Department of Anesthesia, and Clinical Shared Services/Allied Health were considered. If a division has subspecialties that constitute a distinct set of clinical care providers caring for similar groups of patients, access was measured separately for the subspecialty (with division approval). Division subspecialty 3rd Next Available Appointment will be measured for all new visit types that represents the top 80% of new visit volume for each division/subspecialty. The particular visit types that are included are in the table below and have been vetted by each division for accuracy. Visit types volumes will be revalidated every 2 years so the measure truly reflects any changes to the business that might occur as patient demand and potential interventions change things over time. Visit types are considered only if the provider performing the visit represents the primary clinical visit for the patient within each division/subspecialty (i.e. nursing visits are excluded; genetic counselors are excluded for certain divisions; psychologists are excluded for certain divisions)

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If a division/subspecialty is considered the host for a multi-disciplinary clinic (MDC), that will be included for consideration in the top 80%. If the division/subspecialty is not the host clinic, that visit type will be excluded. Access for MDC’s is reliant on the schedule of the host clinic for measurement purposes. As of FY 2017 (unless otherwise noted), the following clinics and the visit type that is reported are listed below: DIVISION/SUBSPECIALTY

Access (3NA NV) # of Visit Types

Adolescent Med

3

179

Allergy/Immunology

2

195

Breastfeeding Medicine

1

~150

Cardiology

6

413

Dermatology

1

91

Developmental & Behavioral Peds (DDBP)

Pediatrics

Total New Visits (Sept 2016)

6

297

1

279

2

480

General and Community Pediatrics

6

175

Healthworks

1

92

Endocrinology Gastroenterology, Hepatology, Nutrition (GI)

Human Genetics

5

143

Infectious Disease International Adoption Center

1

32

TBD

TBD

Neonatology

2

82

Nephrology

2

52

Neurology

6

421

New Visit Types Included THC * NV MD THC * BH MD ED NV THC * NEW CONSULT > 12 YRS OLD ALL * NV FOOD ALLERGY ALL NV BMC LACTATION CONSULTATION CAR * NV GENERAL CAR NV ARRHYTHMIA CAR ** NV CARDIOMYOPATHY CAR NV SYNCOPE CLINIC CAR ** NV HTN CAR NV LIPIDS DER ** NV DDBP NV GENERAL 6 to 14 YO DDBP NV GENERAL 3 TO 5 YEARS OLD DDBP COMM ADOS/DUAL 5 YR & UND DDBP NV R/O ASD 5 AND UNDER DDBP NV ARENA B U3 DDBP NV ARENA A U3 END NV GAS NV GAS ** LIVER NV CLINIC PPC NEWBORN HPC NEWBORN FPC NEWBORN PPC * NEWBORN AVONDALE PPC * NEWBORN PRICE HILL PPC NEW PT CHILD HEA NV HGN * NV GENERAL CLINIC HGN * NV BRCA HGN * NV CONNECTIVE TISSUE HGN * NV RESIDENT HGN * NV GENETIC COUNSELING IDC NEW VISIT Determining applicability as a subspecialty

James M. Anderson Center for Health Systems Excellence

NEO * NV HOSP DISCHARGE NEO ** NV NAS NEP NV NEP ** NV HTN NEU NV NEU * NV HEADACHE CTR MDCH NEU * NV NOS 2-17 YRS NEU * NV MDO

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Surgery

Physical medicine & rehab

4

79

Psychiatry

4

295

Pulmonary medicine

4

205

Rheumatology

2

110

Sports medicine

3

361

NEU * NV HEADACHE 0-20YRS NEU * NV SECOND OPINION PED REHAB NV PED REHAB * NV CP TEAM PED REHAB * NV BRAIN – MDCH PED REHAB * NV TBI PSY ** NV SW PSY ** NV APN PSY ** NV MD PSY ** NV MD AND FELLOW PUL NV PUL ** NV SLEEP APNEA PUL * NV ASTHMA PUL ** NV SLEEP DISORDER RHE NV ATTENDING ONLY RHE NV ATTENDING AND FELLOW SPO * NV SPORTS MEDICINE SPO NV SPO * NV CONCUSSION

Mayerson Center

excluded from measure/no new visit type

Dental

excluded from measure/no Epic data HEM PED NV HEMATOLOGY HVMC ** HEM PED NV – MDCH HEM PED NV BLEEDING DO HEM PED NV VASCULAR HEM PED NV THROMBO HEM LIB ** NV HEMATOLOGY HEM AYA NV SOLID ONC HEM AYA ** NV NEURO ONC – MDC HEM OF PED NV SOLID ONC HEM PED NV SOLID ONC HEM AYA NV SVR NON MDC HEM PED ** NV NEURO ONC –MDCH HEM AYA NV LEUK LYMPH HEM PED NV IMMUNODEF

CBDI - HEM

6

80

CBDI - ONC

7

26

CBDI - BMT

1

12

Complex Care

1

8

BMCP

6

470

Cardiothoracic Surgery

1

24

Ear, Nose, Throat (ENT)

3

864

General Pediatric Surgery Gynecology (Pediatric & Adolescent)

7

261

2

162

Neurosurgery

1

76

Ophthalmology

2

574

11

969

Orthopedics

James M. Anderson Center for Health Systems Excellence

CSN ** COMPLEX CHRONIC NV 120 BMCP NV THERAPY BMCP NV ADHD EVAL BMCP NV NP TEST BMCP NV PAIN BMCP NV TEST BMCP NV SLEEP CDV ** NEW VISIT ENT * NV EARS ENT * NV TONSIL PROBLEMS ENT * NV SUR NV SUR NV TRAUMA SUR * NV 30 SUR * NV G-TUBE COL ** NV SUR * NV PECTUS EXCAVATUM BAR ** INITIAL VISIT GYN NEW GYN > 12 YRS OLD GYN NEW GYN < 12 YRS OLD NSU ** NV OPH * NV NC OPH * NV C ORT * NV FRACTURE ORT * NV UPPER EXT FRACTURE ORT * NV HAND FX

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Others

Plastic surgery

13

472

Urology

3

556

Pain Management

2

31

OT/PT

10

982

Speech Therapy

10

496

2

552

Audiology

ORT * NV SPINE ORT * NV FOOT/ANKLE ORT ** ED NV UPPER EXT FX ORT * NV KNEE ORT * NV HIP ORT ** ED NV FRACTURE ORT * NV BACK AND OR NECK PAIN ORT * NV HAND PLA * NV PLAGIO PLA * NV ORT * NV HAND FX PLA * NV NEVUS OR MOLE PLA * NV ER FOLLOWUP PLA * NV CYSTS ORT * NV HAND PLA SUR * NV WOUND CARE PLA * NV CLEFT LIP OR PALATE>1 PLA * NV FEMALE BREAST ISSUES PLA * NV SUPERNUMERARY DIGITIS HAND PLA * NV LUMPS AND BUMPS PLA * NV SKIN TAGS URO * NV SURGICAL URO * NV HEALTHY BLADDER URO * NV MEDICAL PAI MUSCULOSKELETAL PAI MULTI-DISCIPLINARY PT NV ORTHO OT NV GEN DEV PT NV GEN DEV OT NV DDBP PT NV TORT OT NV HAND PT NV GEN PT NV GEN DEV INFANT PT NV ORTHOTICS DD PT NV DDBP SP NV SL 3+ SP NV VSS SP NV SL 2+ SP NV BIRTH TO 3 SP NV DYSPHAGIA SP NV SP NV DIAGNOSTIC CLINIC SP NV FLUENCY SP ** NV FEES CLINIC SP NV NICU AUD * AE 0-5 YRS AUD * AE 6/OLDR

III. Data Source(s) For divisions using Cadence, the system used to schedule appointments, the data are collected from the call center. Once a week, the call center staff manually goes into the system and attempts to make a “fake” patient appointment for certain appointment type. For each visit type, they “spin” the scanner for the next available appointment and, once that is found, the Call Center agent “spins” 2 more times to identify the 3 rd next available appointment and then records the date for each of the locations as well as the date the agent is spinning.

James M. Anderson Center for Health Systems Excellence

Contact: Amy Anneken

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Data collections rules for division/subspecialty questionnaires are available here: DataCollectionPlan _SchedulingCenterMaster copy TOP 80% Third Next Available.docx

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IV. Sampling and Data Collection Plan One data point is collected, once each week on Tuesdays for selected visit types for each outpatient clinic. The same day of week is used as reference point. For clinics scheduling through other systems, the data should collected out of that system weekly in a similar way. However, only clinics utilizing Cadence will be reported at this time. V. Calculation Overall Outpatient The overall outpatient 3rd Next Available Appointment measure is measured as “3rd Next Available Appointment - % of Divisions at