As the competition for the health care dollar continues, most medical organizations are trying to find more efficient, patient-friendly ways to offer their services. It seems likely that there will be a number of options that will be tried, and perhaps different solutions will be found for different areas of the country. The concept that a single delivery model will serve all areas of the country is probably not realistic.
The “on-site” model described in this article is certainly one of the options to improve delivery of health care. There are a number of interesting findings in the comparison of the on-site model to the traditional model of health care delivery, according to Dr. Urion. The ones I would like to comment on include:
1. Wait for first visit (14 days for the on-site model versus 90 days for the traditional model) 2. Kept appointment rate for new visits (95% versus 67%) 3. Kept follow-up visit appointments (85% versus 50%) 4. Strikingly fewer ER visits and hospitalizations with the on-site model versus traditional model.
These features are not unrelated, as it is clear that timely appointments increase the likelihood that the patient will attend the appointment. I am impressed with the 95% attendance rate in the on-site model though, as my experience has not been quite as impressive. I have worked in both models and have experienced the patient response to timely appointments in on-site clinics firsthand, though I don’t believe I have ever had 95% of the patients show up, even for on-site appointments. I am absolutely convinced, however, that when the “no show” rate is 33% or greater, it is nearly impossible to efficiently schedule a clinic, and the inevitable result is increasing wait time for the appointments.
I am not certain what caused the decreased emergency room usage and lower hospitalization rates, and perhaps this feature requires more study. Regardless, the data presented suggest that the on-site model can be superior to the traditional model of health care delivery, a finding that should encourage others to try versions of the on-site model or other models that might better suit the local health care market.
—John B. Bodensteiner, MD Mayo Clinic Division of Child and Adolescent Neurology
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