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When should this patient be seen again?
M K Chapko1, E S Fisher, H G Welch
1VA Puget Sound Health Care System, Seattle, WA, USA.
Context:
The decision about when to ask a patient to return to the clinic for his or her next visit is common to all outpatient encounters in longitudinal care. It directly affects provider workloads and has a potentially great impact on health care costs and outcomes.
General Question:
What are the effects of lengthening or shortening revisit intervals (the recommended period between one visit and the next) on health status and health care costs?
Specific Research Challenge:
How can we change the average revisit interval while preserving provider input for individual patients?
Proposed Approach:
Patients could be randomly assigned to either short or long revisit intervals. So that provider input would be preserved, providers would select from among three discrete categories of revisit intervals: near-term (1 to 2 months); intermediate-term (2 to 4 months); and long-term (4 to 8 months). On the basis of randomization, patients would receive appointments at either the lower or the upper bound of the category selected.
Potential Difficulties:
Because blinding would be almost impossible, providers might "game" randomization at subsequent visits.
Alternate Approaches:
A comparison of shorter and longer revisit intervals might be achieved with less direct approaches. In one such approach, patients would be randomly assigned to 1) having an appointment made immediately after the initial visit or 2) calling back for an appointment according to the interval recommended by the provider. In another approach, patient panel size would be held constant and providers would be randomly assigned to either an increased or a reduced number of clinic sessions.