(274) Quantifying the Operational Impacts of Varying Patient-Provider Continuity Policies in Prenatal Care

To describe how different policies of patient-provider continuity in prenatal care affect clinical operations.

Study Design:

We conducted a simulation study of an appointment scheduling policy at an academic medical center with 12 ambulatory sites. Each site maintains 40% capacity for obstetric appointments, 20% of which is used for telemedicine. Data inputs were derived from a data set of 4,992 patients at a single academic institution from March 1, 2022 to March 1, 2023. Of the 4,992 patients, 62% were medically high risk, and 38% were medically low-risk. Prenatal schedules are tailored to medical need (high-risk: 13 visits; low-risk 9 visits) and patient preference for modality (in-person or virtual), and patients can transition from low to high-risk with changing diagnoses. We tested 3 scheduling policies: 1) provider continuity: patients are booked only with their provider, and overbooked if there are no available appointments; 2) advanced rescheduling: if a patient’s primary provider does not have capacity, the patient is booked with another provider; 3) just-in-time rescheduling: if an appointment is still overbooked the week of the visit, the patient is rescheduled with another provider. The simulation was run in C++ for a 92 week horizon over 100 replications to assess effects on clinic utilization, overbooking, and patient delays. All metrics were reported as an average across all clinics.

Results: The overbooking rate was higher for the policy that favored provider continuity compared to rescheduling (Policy 1: 16.9%; Policy 2: 0.9%; Policy 3: 0.9%). Capacity utilization was similar across all policies (Policy 1: 80.7%; Policy 2: 81.2%; Policy 3: 81.4%). On average, patient delays measured in weeks were low over the course of their care pathways for all policies (Policy 1: 0.24, Policy 2: 0.61, Policy 3: 0.24).

Conclusion:

Policies that favor provider continuity result in significantly higher overbooking rates for providers, without improving overall clinic utilization. Policies that favor more even distributions of patient loads may result in more effective, efficient clinical operations.