Mark F. Murray, MD, MPA
Potential Financial Conflicts of Interest: Mark Murray & Associates Healthcare consulting group.
Murray M.; Evaluating Open Access: Problems with the Program or the Studies?. Ann Intern Med. 2008;149:909. doi: 10.7326/0003-4819-149-12-200812160-00013
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Published: Ann Intern Med. 2008;149(12):909.
TO THE EDITOR:
I had the opportunity to read the article by Mehrotra and colleagues (1). As one of the authors commonly cited in the article's references section, I feel qualified to comment. Although I applaud the efforts of the practices to make fundamental changes in the way they operate, to make a systematic approach to improvements, and to explore change over time, this investigation contains serious and fundamental flaws. First, my co-authors and I have emphasized that the fundamental dynamic in appointment scheduling is the necessity of balancing or matching patient demand with practice appointment supply or capacity. The first principle in improvement in this field is to fully understand, measure, and achieve a balance between demand and supply. If demand exceeds supply, no system will work. We can develop an understanding of the balance of demand and supply by reviewing 3 critical measures: third-next-available appointment time; daily demand, supply, and activity; and panel size. If the third-next-available appointment measure is stable, this implies a demand–supply balance. If not, it implies a mismatch. If the daily demand, supply, and activity pattern is favorable, then this implies a balance. Finally, the panel size simply must be manageable. The panel capacity limit can be defined by a formula (2, 3).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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