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Publication Briefs

Study Identifies Eight Organizational Target Areas for Improving Access to Primary Care

Providing access to healthcare is a fundamental function and a necessary pre-requisite for judging the quality of healthcare. Yet, few research studies address the needs of organization leaders and managers for continuous, comprehensive, and sustainable access management approaches. This study sought to identify priorities for improving healthcare organization management of patient access to primary care based on prior evidence and a stakeholder panel. The prior evidence included a systematic review of the literature and a study of the experiences of VA access managers to identify factors influencing access. Carried out between January 2016 and May 2018, specific objectives were to: define access management; identify access management priorities; develop recommendations/suggestions for implementation, and references for each priority area; and develop a panel-approved ready-to-use tool summarizing the results. The stakeholder panel of 20 (mostly from within VA) included patients, providers, purchasers, payers, policymakers, and principal investigators.


  • Optimal access to primary care for enrolled patient populations requires active ongoing management of at least eight diverse target areas (two organizational structure targets, four process improvements, and two outcomes):
    1. Clearly identified group practice management structure
    2. Interdisciplinary primary care site leadership
    3. Patient telephone access to ensure patient safety, scheduling, and coordination
    4. Contingency staffing (planned minimal excess staffing to cover routine absences)
    5. Nurse management of demand through care coordination
    6. Proactive demand management by optimizing provider visit schedules
    7. Quality of patients’ experiences of access
    8. Provider and staff morale in relationship to supply-demand mismatch (e.g., provider vacancies, panels exceeding recommended size)


  • These priorities provide valid current guidance on access management improvement for healthcare organization managers and leaders. The resulting tool can provide these individuals, particularly those in integrated healthcare organizations, with a foundation for undertaking access management improvement, while tailoring it to their own contexts.


  • Investigators did not assess the costs or methods for paying for enhanced access to care.

Drs. Rose and Stockdale are part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) in Los Angeles, CA; Dr. Susan Kirsh is Acting Assistant Deputy Under Secretary for Health for Access.

PubMed Logo Rubenstein L, Hempel S, Danz M, Rose D, Stockdale S, Curtis I, and Kirsh S. Eight Priorities for Improving Primary Care Access Management in Healthcare Organizations: Results of a Modified Delphi Stakeholder Panel. Journal of General Internal Medicine. February 2020;35(2):523-530

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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