Increasing Access to Primary Care by Huddling

Timely access to health care is a growing concern as the demand for primary care services continues to grow. Patient-centered medical home models (PCMH) are being used to expand access and delivery in primary care. While most access interventions focus on increasing provider availability, this project targeted the tasks of interdisciplinary team members that impact access. Access is dependent on collaboration among team members and care coordination. Innovative approaches to care delivery require structured communication to be effective. Huddling provides the venue for this to occur. A huddle coaching program was implemented in a PCMH with the goal of increasing patient access to care. Prehuddle activities and scheduled nurse visits were used as surrogate markers for access to measure outcomes. The Plan-Do-Study-Act model was used to facilitate rapid change and overcome barriers. The coaching program focused on the use of a huddle checklist to structure huddles, completion of pre-visit activities to improve care coordination, and utilization of non-traditional encounters to expand capacity. Core skills were taught to support a collaborative practice. Program participants rated the initial training session favorably and huddling was found to be beneficial. Performance-based outcome measures were drawn from existing interdisciplinary team member responsibilities as a part of normal business operations. Return of daily checklists demonstrated a 15% increase in group huddling. Nursing completion of pre-visit activities tripled from the baseline as a result of the intervention. Missed appointment reminder calls were found to strongly correlated with a higher patient no-show rate. A 40% nursing clinic utilization rate, was identified as an underutilized alternative method of care delivery that could be tapped to increase access. The huddle coaching program highlighted the benefits of using a multiprong approach to increase patient access and expand team capacity. Additional benefits may be seen with a continued focus on pre-visit activities and better utilization of alternative care delivery methods.