Gorodeski Eiran Z, Joyce Emer, Gandesbery Benjamin T, Blackstone Eugene H, Taylor David O, Tang W H Wilson, Starling Randall C, Hachamovitch Rory
Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
Center for Connected Care, Medical Operations, Cleveland Clinic, Cleveland, Ohio, United States of America.
PLoS One. 2017 Nov 14;12(11):e0187849. doi: 10.1371/journal.pone.0187849. eCollection 2017.
A 2015 Institute Of Medicine statement "Transforming Health Care Scheduling and Access: Getting to Now", has increased concerns regarding patient wait times. Although waiting times have been widely studied, little attention has been paid to the role of patient arrival times as a component of this phenomenon. To this end, we investigated patterns of patient arrival at scheduled ambulatory heart failure (HF) clinic appointments and studied its predictors. We hypothesized that patients are more likely to arrive later than scheduled, with progressively later arrivals later in the day.
Using a business intelligence database we identified 6,194 unique patients that visited the Cleveland Clinic Main Campus HF clinic between January, 2015 and January, 2017. This clinic served both as a tertiary referral center and a community HF clinic. Transplant and left ventricular assist device (LVAD) visits were excluded. Punctuality was defined as the difference between 'actual' and 'scheduled' check-in times, whereby negative values (i.e., early punctuality) were patients who checked-in early. Contrary to our hypothesis, we found that patients checked-in late only a minority of the time (38% of visits). Additionally, examining punctuality by appointment hour slot we found that patients scheduled after 8AM had progressively earlier check-in times as the day progressed (P < .001 for trend). In both a Random Forest-Regression framework and linear regression models the most important risk-adjusted predictors of early punctuality were: later in the day appointment hour slot, patient having previously been to the hospital, age in the early 70s, and white race.
Patients attending a mixed population ambulatory HF clinic check-in earlier than scheduled times, with progressive discrepant intervals throughout the day. This finding may have significant implications for provider utilization and resource planning in order to maximize clinic efficiency. The impact of elective early arrival on patient's perceived wait times requires further study.
2015年医学研究所发表的一份声明《转变医疗保健预约与就诊：实现即时服务》引发了人们对患者等待时间的更多关注。尽管等待时间已得到广泛研究，但作为这一现象组成部分的患者到达时间的作用却很少受到关注。为此，我们调查了门诊心力衰竭（HF）诊所预约就诊患者的到达模式，并研究了其预测因素。我们假设患者比预定时间更有可能迟到，且一天中越晚的预约患者到达时间越晚。
利用商业智能数据库，我们识别出了2015年1月至2017年1月期间前往克利夫兰诊所主校区HF诊所就诊的6194名不同患者。该诊所既是三级转诊中心，也是社区HF诊所。排除了移植和左心室辅助装置（LVAD）相关的就诊。准时性定义为“实际”和“预定”登记时间之间的差值，负值（即提前准时）表示提前登记的患者。与我们的假设相反，我们发现患者只有少数情况下登记迟到（38%的就诊）。此外，按预约时间段检查准时性时，我们发现上午8点之后预约的患者随着时间推移登记时间逐渐提前（趋势P < 0.001）。在随机森林回归框架和线性回归模型中，提前准时的最重要风险调整预测因素为：当天较晚的预约时间段、患者曾去过医院、70岁出头的年龄以及白人种族。
在混合人群的门诊HF诊所就诊的患者比预定时间更早登记，且全天的差异间隔逐渐增大。这一发现可能对医疗服务提供者的利用和资源规划具有重要意义，以实现诊所效率最大化。选择性提前到达对患者感知等待时间的影响需要进一步研究。
