Consult Coordination Affects Patient Experience

Abstract

Objectives: The Medicare accountable care organization (ACO) program financially rewards ACOs for providing high-quality healthcare, and also factors in the patient experience of care. This study examined whether administrative measures of wait times for specialist consults are associated with self-reported patient satisfaction.

Study design: Analyses used administrative and survey data from a clinically integrated healthcare system similar to an ACO.

Methods: Veterans Health Administration (VHA) data from 2012 was obtained. Administrative access metrics included the number of days between the creation of the consult request and: 1) first action taken on the consult, 2) scheduling of the consult, and 3) completion of the consult. The Survey of Healthcare Experiences of Patients-which is modeled after the Consumer Assessment of Healthcare Providers and Systems family of survey instruments used by ACOs to measure patient experience-provided the outcome measures. Outcomes included general VHA satisfaction measures and satisfaction with timeliness of care, including wait times for specialists and treatments. Logistic regression models predicted the likelihood of patients reporting being satisfied on each outcome. Models were risk adjusted for demographics, self-reported health, and healthcare use.

Results: Longer waits for the scheduling of consults and completed consults were found to be significantly associated with decreased patient satisfaction.

Conclusions: Because patients often report high levels of powerlessness and uncertainty while waiting for consultation, these wait times are an important patient-centered access metric for ACOs to consider. ACOs should have systems and tools in place to streamline the specialist consult referral process and increase care coordination.

Figure.

Consult Wait Calculations Days to first action = 1 day | Days to scheduled = 10 days | Days to completed = 15 days