Interprofessional advanced access: results from a quality improvement intervention in primary care teams
Bibliographic record
Abstract
Context: The advanced access (AA) model has shown considerable success in improving timely access for patients in primary care settings. However, despite its widespread use, few providers other than physicians and nurse practitioners have implemented the model. Among those who have integrated it into their practice, wide variations in the level of implementation of AA processes have been observed, suggesting a need to support primary care teams in continuous improvement with AA implementation. Objective: To document the processes and measure outcomes of a practice facilitation intervention aimed to improve the implementation of AA within interprofessional teams. Study design and analysis: Primary care teams at various levels of organizational AA implementation took part in a quality improvement process facilitated by an external coach who was an expert in AA processes. Data were collected through reflective surveys and electronic medical records. Setting: Eight interprofessional primary care teams in the province of Quebec, Canada. Teams mainly included physicians, nurses, social workers, and pharmacists. Population studied: All healthcare providers, administrative assistants, and managers were invited to participate. Intervention/instrument: The interprofessional primary care teams were independently coached through Plan-Do-Study-Act cycles over 12 to 40 months. Outcome measures: Five key indicators on access and continuity of care were plotted and interpreted using control charts to support the improvement process. Findings: Results are from a total of 151 individuals across the eight teams. Significant improvements were observed at the team level in time to the 3rd next available appointment (decrease of 4 days), use of walk-in clinics (decrease of 20%), availability for urgent reasons for consultation (within 48 hours; increase of 48%), and continuity of care (above 80%). No shows did not vary significantly, but were estimated to be about 2% at baseline. Conclusion: Quality improvement through external coaching can significantly improve access and continuity of care. The implementation of AA processes can be broadened to a diverse group of primary care providers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".