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  5. Performance Measure: Waiting Time for Initial Access to Outpatient/Ambulatory Medical Care

Performance Measure: Waiting Time for Initial Access to Outpatient/Ambulatory Medical Care

National Quality Forum #: None

Description: Percentage of Ryan White HIV/AIDS Program (RWHAP)-funded outpatient/ambulatory care organizations in the system/network with a waiting time of 15 or fewer business days for an RWHAP-eligible patient to receive an appointment to enroll in outpatient/ambulatory medical care1

Numerator: Number of RWHAP-funded outpatient/ambulatory medical care organizations in the system/network with a waiting time of 15 or fewer business days for an RWHAP-eligible patient to receive an appointment to enroll in outpatient/ambulatory medical care1

Denominator: Number of RWHAP-funded outpatient/ambulatory medical care organizations in the system/network at a specific point in time in the measurement year

Exclusions: None

Data Elements:

For each agency:

  1. Is the organization funded by the RWHAP to provide outpatient/ambulatory medical care? (Y/N)
    1. In how many business days is the third next available appointment for an RWHAP-eligible patient to enroll in outpatient/ambulatory medical care at this organization?
      1. Is the third next available appointment <15 business days? (Y/N)

For the system:

  1. How many outpatient/ambulatory medical care organizations are funded by the RWHAP to provide outpatient/ambulatory medical care?
    1. Of those organizations, how many have <15 business days for the third next available appointment to enroll in outpatient/ambulatory medical care?

Data Sources: Data reported to the system/network grantee at a common point in time on a quarterly basis by each of the organizations in the system/network that provides outpatient/ambulatory medical care using a standardized methodology. (See example below.)

Example:

System A, which has six (6) outpatient medical care programs, decided to implement this measure on a quarterly basis. A point in time survey was scheduled to be conducted by telephone on the last Tuesday of the quarter. (Other methods of data collection, such as an on- line survey, email, or fax may be used to collect data at the point in time by the system.) On the designated morning, the System A administrative staff calls each outpatient program and asks the following question: "What are your three next available appointments for an individual who is seeking to enroll in outpatient/ambulatory medical care for his/her HIV disease at your clinic?"

After data is collected from each of the agencies, the waiting time (number of business days from the date of data collection to the appointment date) are calculated for the third next available appointment. Those which are 15 business days or fewer are identified and are counted as the numerator, while the denominator is the total number of ambulatory outpatient medical care providers in the system.

Results of System A Point in Time Survey:

Date of data collection: September 14, 2018 (N=6)

Agency 1: The first available appointment was on 9/14/2018 the wait time was 0 (zero) days. The second available appointment was scheduled on 9/23/18 and with a wait time of 7 days. The third available appointment was 10/15/18 and with a wait time of 23 days. The appointments on 9/14/2018 and 9/23/2018 were within the 15 day appointment window. All of the appointments except for the 10/15/2018 appointment meet the standard of patients having a waiting time of 15 business days or less to receive an appointment to enroll in ambulatory/outpatient care.

Agency 2: The first available appointment was 9/14/2018 the wait time was 0 (zero) days. The second available appointment was also 9/14/2018* the wait time for the appointment is the same as the first appointment, 0 (zero) days. The third available appointment is also 9/14/2018, with a wait time of 0 (zero) days. All of the appointments are compliant with the measure regarding a patient having a wait time of 15 business days or less to receive an appointment to enroll in ambulatory/outpatient care.

Agency 3: The first available appointment was 11/24/2018, with a wait time of 50 days. The second available appointment was 12/15/2018, with a wait time of 64 days. The third available appointment was 1/19/2019, with a wait time of 88 days. None of the appointments met the criteria of a patient receiving an appointment within 15 business days or less for an eligible patient to receive an appointment to enroll in ambulatory/outpatient medical care.

Agency 4: The first available appointment was 9/21/2018 the wait time was 5 days. The second available appointment was 9/21/2018, the wait time was also 5 days. The third available appointment was also 9/21/2018, the wait time was 5 days. All of the appointments are compliant with the measure regarding a patient having a wait time of 15 business days or less to receive an appointment to enroll in ambulatory/outpatient care.

Agency 5: The first appointment was None. The second available appointment was None. The third available appointment was None. None of the patients were seen because the agency was not accepting new patients at the time.

Agency 6: The first appointment was 9/14/2018, with a wait time of 0 (zero) days. The second available appointment was 9/17/2018, with a wait time of 3 days. The third available appointment was 9/20/2018, with a wait time of 4 days. All of the appointments are compliant with the measure regarding a patient having a wait time of 15 days business days or less to receive an appointment to enroll in ambulatory/outpatient care.

*Note: Different appointment times on the same day counts as separate appointment times.

Using the data collected, the performance measure is calculated by identifying the number of agencies that indicate that their third next available appointment is within 15 or fewer business days. In the example above, three of the agencies meet this criteria (Agencies 2, 4 and 6) and three (Agencies 1, 3 and 5) do not. Even though Agency 5 is closed to new patients, they are still included. The numerator is 3 and the denominator is 6. The percent of RWHAP-funded outpatient/ambulatory medical care organizations in the system/network with a waiting time of 15 or fewer business days for an RWHAP-eligible patient to receive an appointment to enroll in outpatient/ambulatory medical care at this point in time is 50%. (Calculated by dividing the numerator by the denominator: (3÷6) x 100= 50%)

In addition to determining the rate of achievement of the performance measure, the average number of days until the third next available appointment across the system/network can also be calculated: Add the number of days for the third next available appointments (in this example the sum is 121 days) and then divide by the number of agencies in the system who report an available appointment (in this example the number is 5). The average number of days for the third next available appointment in the system/network reported on the date of data collection is 24.2 days. (Note: In this example Agency 5 reports that it is not accepting new patients—no appointments are available. This agency should still be included in the denominator for the calculation of the performance measure rate [Example 1] but it should not be included in the denominator for the calculation of the average number of days [Example 2]).

The numbers below depict the percentage of agencies meeting the performance measure over three quarters.

Example: Performance measure rates for Quarters 1 through 3 are listed below:

  • Quarter 1= 52%
  • Quarter 2= 72%
  • Quarter 3= 50%

National goals, target, or benchmarks for comparison

The HIV Quality Measures (HIVQM) Module is a tool within the Ryan White HIV/AIDS Services Report portal. It allows recipients to enter aggregate data specific to HRSA HAB Performance Measures. The HIVQM Module allows recipients to conduct point-in-time benchmarking across Ryan White HIV/AIDS Programs that use the module.

Outcome measures for consideration

  • Percent of patients who are retained in outpatient/ambulatory medical care in the measurement year
  • Percent of patients diagnosed with Pneumocystis jiroveci (PCP) in the measurement year

Basis for selection

This measure addresses the importance of access to health care for RWHAP-eligible patients. Improving access to healthcare is important to the quality of healthcare outcomes. "Access to care is the attainment of timely and appropriate health care by patients or enrollees of a health care organization or clinician."2 A study of the characteristics of scheduled new HIV+ patients who failed to attend their initial visit in clinics found that in addition to patient characteristics (younger age, black race, and public insurance), patients who experienced longer wait times between the time they scheduled their new visit and the actual appointment were more likely to not establish care.3

Department of Health and Human Services Clinical Practice Guidelines

None

Use in other federal programs

None

References/notes

1 The type of visit for patient enrollment in outpatient/ambulatory medical care can be determined by each outpatient/ambulatory medical care provider in the system/network, but should be consistently defined at each data collection point. The type of appointment scheduled to enroll in outpatient/ambulatory medical care may vary among agencies within the system/network. For example, at one agency, to enroll in care, a new patient may first have an appointment to have routine laboratory tests and an initial health history taken by a nurse to then be followed by a subsequent appointment with a provider with prescribing privileges at the agency (i.e., MD, PA, NP). While at another agency, a new patient may first have an appointment with physician. Other examples of types of appointments to enroll in outpatient/ambulatory medical care may include an initial appointment with a case manager, social worker, patient navigator, peer advocate, clergy, or other designated staff.

2 Institute of Medicine. Lohr KN, editor(s). Medicare: a strategy for quality assurance. Vol. 1. Washington (DC): National Academy Press; 1990 May. p. 21. Available online at https://www.ahrq.gov/gam/summaries/domain-definitions/index.html. Accessed January 2022.

3 Mugavero MJ, Lin HY, Alison JJ, et al. Failure to Establish HIV Care: Characterizing the "No Show" Phenomenon. Clinical Infectious Diseases. 2007; 45:127-130.

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