Next Generation Appointment Systems

描述（由申请人提供）：作为患者和卫生服务提供者之间的第一个接触点，预约系统是患者总体满意度的重要决定因素。 它们可以提高资源的利用率，使工作量与可用容量相匹配，并使患者流动顺畅。 然而，有关任用制度管理的重要决策是在没有决策支助工具的情况下作出的。 例如，一些服务提供者正在采用当天预约制度。 根据这一计划，鼓励医生清理积压的工作，并设法在同一天看到所有要求预约的病人。 虽然这种系统在几个大型诊所的初步实施中取得了成功，但其长期成功并没有保证。 更重要的是，文献中没有足够的研究来了解它的成功因素，它可能会动摇的条件，以及如何监测和改进。 本研究项目的总体目标是通过开发一套可用于设定政策参数的分析工具来填补这一空白。 具体而言，本项目将处理的假设如下： 1.工作时间不太不规律、工作时间更稳定的医生，应该有更少的目标空缺数; 2.比较统一的工作日时间表（非标准任用时间较少）更适合于当日任用; 3.存在一个需求与能力的最低比率，如果超过这一比率，成功实施当日预约制度的能力就会受到严重损害; 4.数学模型可以帮助识别管理开放时隙的定时、受保护时隙的释放和双重预订的最佳决策规则。 项目目标将通过多管齐下的方法实现。 来自已实施当日预约系统的诊所的数据将用于检验上述假设，并估计参数值。 与此同时，将开发数学和计算机模拟模型，以评估现有管理做法的稳健性，并确定最佳决策规则。 这项研究将从两个方面影响实践： 1)它将使决策者能够使用科学方法来设定政策参数; 2)它将为建立下一代计算机辅助预约系统提供一个框架，使病人能够通过互联网预约。

DESCRIPTION (provided by applicant): As the first point of contact between patients and health service providers, appointments systems are important determinants of overall patient satisfaction. They can increase the utilization of resources, match workload to available capacity, and smooth the flow of patients. Yet, important policy decisions concerning the management of appointment systems are made without the benefit of decision-support tools. For example, some service providers are adopting a same-day appointments system. Under this scheme, physicians are encouraged to clear their backlog and to attempt to see all those patients who call for appointments the same day. While such a system has been successful in preliminary implementation at several large clinics, its long-term success is not guaranteed. More importantly, there is not enough research in the literature to provide an understanding of its success factors, conditions under which it may falter, and how it could be monitored and improved. The overall goal of this research project is to fill this gap by developing a suite of analytical tools that can be used to set policy parameters. Specifically, the hypotheses that will be addressed in this project are as follows: 1. a physician whose work schedule is less irregular, who has a more stable work schedule, should have a smaller target number of open slots; 2. more homogeneous work-day schedules (with fewer non-standard appointment lengths) are better suited for same-day appointments; 3. there exists a threshold ratio of demand to capacity above which the ability to successfully implement a same-day appointment system is seriously jeopardized; 4. mathematical models can help identify optimal decision rules governing timing of open slots, release of protected slots, and double-booking. The project goals will be achieved via a multi-pronged approach. Data from a clinic that has implemented a same-day appointments system will be used to test the above hypotheses, and to estimate parameter values. At the same time, mathematical- and computer-simulation models will be developed to evaluate the robustness of the existing management practices and to identify optimal decision rules. This study will impact practice in two ways: 1) it will allow policy makers to use a scientific approach to set policy parameters; and 2) it will provide a framework for building of the next generation of computer-assisted appointment systems that allow patients to set appointments via the Internet.