A Decision-Support Approach for Provider Scheduling in a Patient-Centered Medical Home.

EXECUTIVE SUMMARY: The patient-centered medical home (PCMH) has been proposed as a viable and medically effective model of primary care delivery. The fundamental principles of a PCMH address increased access and offer new ways to organize a practice. Creating provider schedules able to satisfy the operational and organizational constraints imposed by this type of delivery model is a challenging, complex, and time-consuming task.This article presents a two-step approach for scheduling providers and prospectively assessing the consequences of various schedules on patient throughput without experimenting on the real-world system. The first step uses an original integer programming model to address the tactical planning problem of assigning provider duties to defined shifts while incorporating a number of constraints. Given provider scheduling preferences and availability, a monthly schedule is determined to satisfy the expected demand. The second step consists of quantifying capacity increases that result from adjustments to operating hours, physician availability, and examination room availability. A discrete-event simulation model is used to assess the impact of various proposed operating configurations on patient throughput.