Access to Care and Patient Satisfaction Assessment

Access to Care and Patient Satisfaction Assessment: Newark Wellness Center

Suravi G. Thomas

MD/MPH

St. George’s University School of Medicine

1

Background: The Newark Wellness Center is part of Alameda Health System’s

Network of community-based ambulatory clinics. The goal of the clinic is to expand

access to primary care within the community. Though located in Newark the clinic

receives patients the surrounding cities as well. Since Newark Wellness Center

treats predominantly immigrant populations and patients of lower socioeconomic

status, there are several potential barriers to access to care from language to

transportation. The clinic has implemented interventions to provide equal and

timely access to care to all it’s patients. This project was a way to evaluate the

effectiveness and reach of those interventions.

Objective: The goal of this study was to assess the quality and access to care

received at the Newark Wellness Center.

Methods: An initial pilot survey was designed that featured 13 questions (Appendix

1). These questions were carefully selected to capture the quality of care provided to

patients. The sampling took place over the course of 5 days. 60 questionnaires were

randomly administered to patients that had appointments for the Pediatrics Clinic,

Adult Medicine Clinic or Women’s Health Clinic.

Trained persons administered the 5-7 minute survey during the period of time the

patient was in the room waiting to see the physician. The patients were provided

informed consent and had the option to refuse participation. Each survey was

marked with the patient ID as a manner of tracking which clinic the patient had an

appointment with. The optimal time for data collection was between 8:30a-11:30a

on Wednesday, Thursday and Friday.

Results/ Analysis: When analyzing the data it was broken down into three areas of

significance. It was important to analyze the reach the clinic has within the

community, the access of care to those in need and overall patient satisfaction.

There were some notable trends in the data gathered and are presented below. The

2

scoring has been set up such that the higher the value the better the evaluation from

the view of the patients.

1. Access to Care

When examining the barrier of access posed by language this pilot study

proved that the Newark Health Center has implemented successful

interventions to combat this challenge.

According to the data, 89% of the patients received treatment in their

preferred language. With the assistance of a translator, another 11%

received services with adequate comprehension.

What is notable however, was the barrier to access posed by limits in

transportation. The majority of the patients, though from Newark (Fig. 1),

still had a limitation in that almost a quarter of the patients did not drive and

were resorting to public transportation or an alternate mode of

transportation (walking, ride from a friend etc.)

Newark Fremont Union City Hayward Other0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%38.46%

12.31%

7.69%

18.46%

23.08%

What is your city of residence?

Fig. 1

3

While it was unclear where “Other” was as a city of residence for patients of

the clinic it is surprising to see that 20% were travelling greater than 15

miles to make this appointment (Fig. 2)

1 mile 1 to 5 miles 5 to 15 miles Greater than 15 miles

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

26.15%

32.31%

21.54% 20.00%

How far did you travel to get to this appointment?

Fig. 2

From the graph below one can conclude that this center is well access and

held in high regards to it’s provision of access to it’s patients (Fig. 3)

Scoring: Newark Access to Community

Statistic Value

Min Value 12Max Value 25Sum 1381Mean 21.24615385Weighted Mean 3.035164835Variance 6.688461538Standard Deviation 2.586206012Total Responses 65Percentage 84.98461538

21.25

21 25 12

4

Fig. 3

2. Patient Satisfaction

As seen in the data, greater than 58% of the patients were scheduled for an

appointment date within 1 week of their preferred date (Fig. 4 ) with the

majority requesting time early in the morning (Appendix 2).

Within 1 week Within 15 days Within 1 month Greater than 1 month

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%58.46%

20.00%13.85%

7.69%

How close was this appointment from your preferred date?

Fig. 4

Similarly, the majority of the patients spoke with a receptionist within 5 minutes of

their arrival. (Fig. 5)

5

Within 5 minutes Within 5 to 10 minutes

Within 15 to 30 minutes

Greater than 30 minutes

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

How long did you have to wait in line to talk to a receptionist?

Fig. 5

These statistics are notable as they point to the reasoning behind the high level of

patient satisfaction (Fig. 6). As seen below on a rating of 0-5 where 0 is the worst

experience and 5 is the best, Newark Wellness Center was held in high regards as it

scored an average of 4/5.

0 1 2 3 4 50.00%

10.00%

20.00%

30.00%

40.00%

0.00%3.08% 3.08%

23.08%

30.77%

40.00%

On a scale of 0-5, where 0 is the worst and 5 is the best how would

you rate this clinic?

Fig. 6

6

When looking at the picture in it’s entirety, Newark Wellness Clinic scores high on

the scale assessing patient satisfaction as can be seen below (Fig. 7).

Scoring: Patient Satisfaction with Newark Clinic

Statistic Value


Fig. 7

3. Reach within the Community

Primarily it was important to look at Newark Wellness Center’s reach within the immediate and extended community. Seen in the value below (Fig. 8), this clinic is accessed not just by those the in the city of Newark but also others in the neighboring community.

Scoring: Reach in Community of Newark

Statistic Value

Min Value 5

9.66

9 123

7

Max Value 13Sum 607Mean 9.338461538Weighted Mean 2.334615385Variance 6.039903846Standard Deviation 2.457621583Total Responses 65Percentage 71.83431953

Fig. 8

Limitations: Even though one was able to create a scoring system in which a higher

value represented a better score and in which negative questions were accounted

for, the value obtained lacks validity. This is due to the lack of internal and external

validation of the questions. Though preliminary results show high outreach, patient

satisfaction and access to care, to determine the extent of these individual factors a

more thoroughly constructed survey is necessary.

Conclusion: The Newark Wellness Center is a highly regarded clinic that is a pillar

of this and surrounding communities. With a professional and welcoming staff, clean

environment and impeccable service it is no wonder that this clinic draws patients

from many miles. This study was essential in concluding that the interventions

currently in place by the Newark Wellness Center are well regarded.

To better understand existing barriers, a secondary survey was created such that it

would have increased internal and external validity and would prove most useful for

powerful statistical analysis. Although multiple instruments were examined, the

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

questionnaires as the most widely used and survey with the most empirical

9.33

9 135

8

research supporting its reliability and validity. Based off CAHPS visit survey 2.0, a

questionnaire of 10 questions that asked adults and children about their experience

with care at their most recent visit to a doctor’s office was constructed (Appendix 3).

Understanding that access to care extends beyond physician access but also includes

health literacy and transportation access, these questions were also included to

hone in on these target areas as well.

This survey would be most useful if it were to be administered in a similar manner

would yield results that had validity and questions that would explicitly query the

quality and access to care provided at the center with powerful statistics that can be

used in the analysis of these interventions.

9

Appendix

Appendix 1: Pilot Survey

Q1. How close was this appointment from your preferred date? Within 1 week Within 15 days Within 1 month Greater than 1 month

Q2. Was this to your preferred time of service? Yes No

10

Q3. If no, when is your preferred time of service? Between 9 am to 12 pm Between 1 pm to 5 pm Between 5 pm to 8 pm

Q4. How far did you travel to get to this appointment? 1 mile 1 to 5 miles 5 to 15 miles > 15 miles

Q5. What was your mode of transportation? Private car Public transportation Other

Q6. Do you drive? Yes No

Q7. Did you walk-in or did you make an appointment for today? Walk-In Appointment

11

Q8. What is your city of residence? Newark Fremont Union City Hayward Other

Q9. How long did you have to wait in line to talk to a receptionist? Within 5 minutes Within 5 to 15 minutes Within 15 to 30 minutes Greater than 30 minutes

Q10. Were you communicated with in your preferred language? Yes No, but I was able to fully understand No

Q11. How long have you been visiting this provider? <1 year 1-5 years >5 years

Q12. How often did you get an appointment as soon as you needed? Most of the Time Rarely Never

Q13. On a scale of 0-5, where 0 is the worst and 5 is the best how would you rate this clinic? 0 1 2 3 4 5

Appendix 2: Raw Data

Pilot Study-- Access and Quality of Care Assessment

12

Type of Care/Service

Type of Care/Service

# Answer Bar Response %1 Adult 73.85% 48 73.85%2 Pediatric 26.15% 17 26.15%



# Answer Bar Response %

1Within 1 week 58.46% 38 58.46%

2Within 15 days 20.00% 13 20.00%

3Within 1 month 13.85% 9 13.85%

4

Greater than 1 month 7.69% 5 7.69%

Was this to your preferred time of service?

Was this to your preferred time of service?

# Answer Bar Response %1 Yes 93.85% 61 93.85%2 No 6.15% 4 6.15%

If no, when is your preferred time of service?

If no, when is your preferred time of service?


1

Between 9 am to 12 pm 66.67% 4 66.67%

13

2

Between 1 pm to 5 pm 16.67% 1 16.67%

3

Between 5 pm to 8 pm 16.67% 1 16.67%



# Scoring Answer Bar Response %

1 ✔ 1 mile 26.15% 17 26.15%

2 ✔ 1 to 5 miles 32.31% 21 32.31%

3 ✔ 5 to 15 miles 21.54% 14 21.54%

4 ✔Greater than 15 miles 20.00% 13 20.00%

What was your mode of transportation

What was your mode of transportation


1 ✔ Private Car 70.77% 46 70.77%

2 ✔Public Transportation 12.31% 8 12.31%

3 ✔ Other 16.92% 11 16.92%

Do you drive?

Do you drive?

# Answer Bar Response %1 Yes 75.38% 49 75.38%2 No 24.62% 16 24.62%

14

Did you walk-in or did you make an appointment for today?

Did you walk-in or did you make an appointment for today?


1 ✔ Walk-In 13.85% 9 13.85%

2 ✔ Appointment 86.15% 56 86.15%




1 ✔ Newark 38.46% 25 38.46%2 ✔ Fremont 12.31% 8 12.31%

3 ✔ Union City 7.69% 5 7.69%4 ✔ Hayward 18.46% 12 18.46%5 ✔ Other 23.08% 15 23.08%




1Within 5 minutes 56.92% 37 56.92%

2Within 5 to 10 minutes 18.46% 12 18.46%

3

Within 15 to 30 minutes 12.31% 8 12.31%

4

Greater than 30 minutes 12.31% 8 12.31%

Were you communicated with in your prefered language?

15

Were you communicated with in your prefered language?

# Answer Bar Response %1 Yes 89.23% 58 89.23%

2

No, but I was able to fully understand 10.77% 7 10.77%

3 No 0.00% 0 0.00%

How long have you been visiting this provider?

How long have you been visiting this provider?


1Less than a year 60.00% 39 60.00%

2 1-5 year 32.31% 21 32.31%

3

Greater than 5 years 7.69% 5 7.69%

How often did you get an appointment as soon as you needed?

How often did you get an appointment as soon as you needed?


1Most of the Time 87.69% 57 87.69%

2 Rarely 10.77% 7 10.77%3 Never 1.54% 1 1.54%

On a scale of 0-5, where 0 is the worst and 5 is the best how would you rate this clinic?

On a scale of 0-5, where 0 is the worst and 5 is the best how would you rate this clinic?

# Answer Bar Response %1 0 0.00% 0 0.00%

16

2 1 3.08% 2 3.08%3 2 3.08% 2 3.08%4 3 23.08% 15 23.08%5 4 30.77% 20 30.77%6 5 40.00% 26 40.00%



Statistic Value




Statistic Value



17


Statistic Value


18

Appendix 3: Modified Survey based on CAHPS

Q1. Is this the doctor you usually see if you need a check-up, have a health problem, get sick or hurt? Yes No

Q2. How long have you been going to this doctor? <1 year 1-5 years >5 years

Q3. How close was this appointment from your preferred date? Within 1 week Within 15 days Within 1 month > 1 month

Q4. What is your preferred time of service? Between 9 am to 12 pm Between 1 pm to 5 pm Between 5 pm to 8 pm

Q5. What is your city of residence? Newark Fremont Union City Hayward Other

Q6. What was your mode of transportation? Private car Public transportation Other:_________________________________

19

Q7. Wait time includes time spent in the waiting room and the exam room. How often did the doctor see you within 15 minutes of your appointment time? Never Sometimes Usually Always

Q8. Were you communicated with in your preferred language? Yes No, but I was able to fully understand No

Q9. How often did the doctor explain things in a way that was easy to understand? < Never Sometimes Usually Always

Q10. On a scale of 0-5, where 0 is the worst care possible and 5 is the best care possible how would you rate all the health care providers and this clinic? 0 Worst care possible 1 2 3 4 5 Best care possible

20

Access to Care and Patient Satisfaction Assessment

Documents

Transcript of Access to Care and Patient Satisfaction Assessment