Results Summary

What was the research about?

Community health centers, or CHCs, often want to improve access to care so that patients can get health care easily. Improved access includes patients getting appointments when needed, without a long wait.

In this study, the research team looked at appointment scheduling at seven CHCs in Indiana. The team learned from community members that the biggest problems patients had in getting access to care were

  • Not being able to get appointments when needed
  • Long wait times between calling the CHC and getting an appointment

The team used computer simulations to create new ways of scheduling appointments. They custom-made solutions to test at three of the CHCs.

What were the results?

Two of the three CHCs that used new ways of scheduling had positive changes in patient appointments. The first CHC had shorter appointment wait times and fewer patient cancellations. The second CHC had more same-day appointments and shorter appointment wait times. However, this clinic also saw slightly fewer patients per hour.

Among the four clinics that did not test new scheduling practices, three also saw changes. The first CHC had slightly more same-day appointments and slightly fewer patient no-shows. However, the second CHC had fewer same-day appointments and more patient cancellations. The third CHC had longer appointment wait times.

Who was in the study?

The research team worked with seven CHCs in Indiana. The CHCs served patients from different racial and ethnic backgrounds with and without health insurance.

What did the research team do?

To find out what made it hard for patients to get appointments, the research team worked with patients and CHC staff and clinicians. The team used appointment-scheduling data from electronic health records and computer simulations to suggest new strategies for each CHC. With these data, the team created new ways of scheduling appointments.

The team picked three of the seven CHCs to start scheduling appointments using the new strategies. The other four kept scheduling appointments the same way they did before. After six months, the team looked at each of the seven clinics to see if there were changes.

Patients, clinicians, and a group that represents clinics in Indiana helped design and conduct the study.

What were the limits of the study?

Each CHC used a different way to schedule appointments. As a result, it is hard to know which scheduling methods helped people get better access to care. Future research could look at different ways to improve access to care.

How can people use the results?

CHCs could use computer simulations to identify problems and help tailor solutions when considering ways to improve access to care.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers observed that the study did not focus on addressing which strategies are effective for enhancing access but instead on finding strategies that patients and other stakeholders identify as important or promising. The researchers agreed that their focus was to find patient-centered strategies to improve access to care. Rather than find the most effective strategies, the researchers wished to identify a collection of useful strategies. They removed the word, effective, from the research question.
  • Reviewers also noted that the second research question, which regards the Delphi panel approach and modeling to identify the best strategies and policies, did not involve any evaluation that could actually test whether the best strategies were identified. The researchers acknowledged that the work on this research question did not involve a test of healthcare strategies but rather used an iterative process to derive the best strategies based on expert opinion.
  • Reviewers noted that the study did not completely implement the culture-change intervention although it seemed to hold promise as a feasible and impactful strategy. The researchers explained that completing the culture-change intervention would take years, but even so, they felt the study was of value in providing a structured approach that helped clinics start the process.

Conflict of Interest Disclosures

Project Information

Huanmei Wu, PhD^
Indiana University- Purdue University at Indianapolis
Improving Healthcare Systems for Access to Care and Efficiency by Underserved Patients

Key Dates

May 2013
January 2019

Study Registration Information

^ Bradley Doebbeling, BS, MD, MS was the original principal investigator for this project.


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Last updated: January 25, 2023