For a study, the researchers sought to determine if shorter (15-minute) primary care appointments were inferior to longer (≥30-minute meetings in terms of downstream healthcare consumption within 7 days following the initial session. Researchers used data from 5 primary care clinics in the Midwest United States to conduct a retrospective cohort analysis using electronic health record (EHR), billing, and administrative scheduling data. Adult patients who had an acute Evaluation & Management visit between October 1, 2015, and September 30, 2017, were included in the study. Patients with 15-minute appointments were propensity score-matched to those with 30-minute appointments. Within 7 days after the encounter, multivariate regression models looked at the effects of appointment length on repeat primary care visits, emergency department (ED) visits, hospitalizations, and diagnostic services. Baseline patient, visit, and provider variables were factored into the models. The method used was non-inferiority. Researchers found 173,758 total index visits (6.5% 15-minute visits, 93.5% ≥30-minute visits). A total of 11,222 15-minute appointments were matched to a 30-minute visit. Patients with more comorbidities, trainee physicians, and patients with weak English proficiency had longer appointments. Repeat primary care visits (OR=0.983, CI: 0.873, 1.106) and ED trips (OR=0.856, CI: 0.700, 1.047) had no significant effect on the length of scheduled appointments. Lower rates of subsequent hospitalizations (OR=0.689, CI: 0.504, 0.941), laboratory services (OR=0.682, CI: 0.643, 0.724), and diagnostic imaging services (OR=0.499, CI: 0.466, 0.534) were linked to shorter consultations. None of the non-inferiority criteria were met. Shorter duration appointments might be a non-inferior option for scheduling patient care that does not result in increased downstream healthcare use for certain purposes and low-risk individuals. As health systems and payers re-examine how to effectively deliver care to rising patient populations, the outcomes can help guide healthcare delivery models and triage processes.
SOURCE:bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01644-8
