Joint visit in primary care clinics: Modeling, analysis, and an application study. Issue 2 (3rd April 2018)

• Record Type: Journal Article
• Authors: Lee, Hyo Kyung; Zhong, Xiang; Li, Jingshan; Musa, Albert J.; Bain, Philip A.
• Is Part Of: IISE transactions on healthcare systems engineering. Volume 8:Issue 2(2018)
• Page Start: 93
• Page End: 109
• Publication Date: 2018-04-03
• Subjects: Primary care -- patient flow -- joint service -- length of visit -- Markov chain -- iteration; Biomedical engineering -- Periodicals; Medical informatics -- Periodicals; Medical care -- Periodicals; 610.28
• DOI: 10.1080/24725579.2017.1418766
• Languages: English
• ISSNs: 2472-5579

Abstract

ABSTRACT: To improve patient flow and reduce provider workload, joint visit has been proposed and implemented in many primary care clinics. In such systems, the provider and medical assistant (MA) visit the patient jointly; while the provider diagnoses and interacts with the patient, the MA handles necessary documentation work. This article introduces Markov chain models of patient flow with joint visits, and investigates the system behavior under different scenarios. To reduce the state space dimension, convergent iterative procedures are proposed. The study is extended to the non-Markovian case by introducing empirical formulas based on the mean and coefficient of variation (CV) of service times. The results have been validated with good accuracy. To illustrate the applicability of the methods, an application study at Dean East Clinic is presented.