Glossary - Enhanced Access

Activity: Actual number of short appointment slots used that day.

Activity will be less than supply on a day where there are no-shows or unfilled appointment slots. Activity will be more than supply if additional patients were seen. These are often called “squeeze-ins”, because they are beyond the appointment times originally offered.

Backlog: Number of appointments booked between now and the third next available appointment or TNA.

Planned Backlog: Appointments purposely scheduled in the future based on provider decisions or patient choices.
Unplanned Backlog: Appointments booked in the future due to lack of availability today.
 

Carve-outs: Appointment slots reserved in the schedule for certain types of care or specific patients. 

CII/CPAR: Provides important information about how patients are accessing care in the system.

CII allows providers to send select patient information from the clinic EMR to Alberta Netcare, including consult letters and information about patient visits to contribute to Community Encounter Digests (CEDs).

CPAR identifies relationships between patients and their primary provider in Netcare.

Caseload: A group of patients for whom a non-family medicine specialist or team member provides care. The care received by patients on a caseload is usually focused on a specific referral reason.

Continuity of care reflects the patient’s experience of care over time as consistent, connected and coordinated.

There are three aspects of continuity that work together: relational continuity, informational continuity, and management continuity.

Cycle Time: Total patient time in clinic. This is the elapsed minutes from when a patient arrives for an appointment to when they leave the clinic.

Demand: The demand for appointments.

In primary care, annual demand is calculated as:
(Panel size) x (Average visits to any family physician). 

For specialists and team members with a caseload, demand for appointments comes from new referrals waiting for initial consultation, as well as existing patients on a caseload requiring follow-up appointments. 

EMR: Electronic patient files that a physician or other provider uses instead of paper files stored on shelves.

The Primary Healthcare Panel Reports use administrative health data from Alberta Health and Alberta Health Services to provide information about a provider’s patient panel.

Brief team meetings to improve communication and visit flow.

Ideal Panel Size: The number of patients on a panel that is likely to lead to balance between supply and demand.

Calculated as:
(Annual supply of appointments) / (Average visits to any family physician).

Average visits to any family physician is a measure defined and obtained from a provider’s HQCA Primary Healthcare Panel Report. By capturing all of the visits a provider’s patients had to primary care, not just to their paneled physician, we can better understand the full care needs of a panel of patients.

For primary care providers without access to the report, the return visit rate can be used, but this will omit any visits to other primary care providers.

Max-Packing: A way to maximize visit efficiency by addressing more than one health concern during a visit, to reduce future visits.

No-Shows: Occurs when a patient has missed their scheduled appointment without notifying the clinic.

The no-show rate is calculated as:
(Total # of no-show appointments / total # of appointments booked) x 100

Panel: A group of patients to whom a primary care provider and team is responsible for providing comprehensive and longitudinal care. There is a confirmed relationship between the provider and the patient.

Patient Time with Provider: Also called red zone time. Total number of minutes a patient spends in direct contact with their provider.

Relational continuity is the ongoing, trusting therapeutic relationship between a patient and a primary care provider and team, where the patient sees this primary care physician most of the time.

High relational continuity is achieved when patients visit their own primary care physician at least 80 percent of the time.

Return Visit Rate (RVR): Also known as follow-up frequency or return visit interval. RVR reflects how often patients typically see their provider over the course of a year.

For primary care, this is best calculated using the ‘average visits to any family physician’ value from the HQCA patient panel report, as that includes visits to any family physician, not just their designated provider.

Sequence to Achieve Change: A stepwise change management approach that outlines the key steps teams should take when engaging in quality improvement work.

Supply: The number of appointment slots in the provider’s schedule over a specified period.

Annual supply is calculated as:
(Provider appointments per week) x (Provider weeks worked per year) 

TNA: The length of time in days between when a patient requests an appointment and the third next available appointment open in the provider’s schedule.

The third next available is used rather than the next available appointment because it is a more accurate reflection of true availability of the provider. Days when the clinic is closed, like weekends and holidays, are counted because it reflects the patient experience.