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Improving access in a VA primary care clinic using an innovative Panel Retention Tool: a quality improvement report
  1. Andrew T Harris1,2,
  2. Catherine Hoover1,
  3. Brendan Cmolik3,
  4. Mariel Zaun3,
  5. Corinna Falck-Ytter1,2,
  6. Mamta K Singh1,2
  1. 1 Department of Internal Medicine, Louis Stokes VA Medical Center, Cleveland, Ohio, USA
  2. 2 Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  3. 3 Department of Informatics and Analytics, Louis Stokes VA Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Dr Andrew T Harris, Internal Medicine, Louis Stokes VA Medical Center, Cleveland, Ohio, USA; andrew.harris5{at}


Background Loss to follow-up is an under-recognised problem in primary care. Continuity with a primary care provider improves morbidity and mortality in the Veterans Health Administration. We sought to reduce the percentage of patients lost to follow-up at the Northeast Ohio Veterans Affairs Healthcare System from October 2017 to March 2019.

Methods The Panel Retention Tool (PRT) was developed and tested with primary care teams using multiple Plan, Do, Study and Act cycles to identify and schedule lost to follow-up patients. Baseline data on loss to follow-up, defined as the percentage of panelled patients not seen in primary care in the past year, was collected over 6 months during tool development. Outcomes were tracked from implementation through spread and sustainment (12 months) across 14 primary care clinics.

Results Of the 96 170 panelled patients at the beginning of the study period, 2715 (2.8%) were found to be inactive and removed from provider panels, improving panel reliability. Among the remaining, 1856 (1.9%) patients without scheduled follow-up were scheduled for future care, and 1239 (1.3%) without recent prior care completed encounters during the study period. The percentage of patients lost to follow-up decreased from 10.1% (lower control limit (LCL) 9.8%–upper control limit (UCL) 10.4%) at baseline to 6.4% (LCL 6.2%–UCL 6.7%) postintervention and patients without planned future care decreased from 21.7% (LCL 21.3%–UCL 22.1%) to 17.1% (LCL 16.7%–UCL 17.5%).

Conclusions The PRT allowed primary care teams in an integrated health system to identify and schedule lost to follow-up patients. Ease of use, adaptability and encouraging outcomes facilitated spread. This has the potential to contribute to more appropriate utilisation of healthcare resources and improved access to primary care.

  • quality improvement
  • primary care
  • ambulatory care

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  • Contributors All authors are employed by the VA and perform QI as part of their regular assigned roles.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.