The STAT model improves access to sub-acute ambulatory and community services: A stepped wedge cluster randomised controlled trial

Dr Katherine Harding1,2, Ms Annie  Lewis1,2, Professor Nick Taylor1,2, Professor Sandy Leggat2, Assoc Professor Jenny Watts3

1Eastern Health, Melbourne, Australia, 2La Trobe University, Bundoora, Australia, 3Deakin University, Melbourne, Australia

Background: Poor access to sub-acute ambulatory care and community services has health and economic costs, and increases pressure on patient flow. The STAT model (Specific Timely Appointments for Triage), involves creation of protected appointments for initial assessment based on analysis of demand coupled with initial targeted strategies for patients currently on the waitlist. STAT reduced waiting time in two pilot trials but it was not known if it could be applied broadly across other ambulatory and community services. This NHMRC-funded trial aimed to determine whether the STAT model could reduce waiting time not just in a single, well controlled site, but be broadly applied to a range of ambulatory and community services.

Methods: We conducted a stepped wedge cluster randomised controlled trial (ACTRN12615001016527) involving 8 sites within a large metropolitan health network (n=3,116 patients) comparing STAT with a previously used waitlist and triage approach. The primary outcome was time from referral to first appointment; secondary outcomes measured other aspects of service delivery in the 12 weeks after initial appointment.

Results: Mean time from referral to first appointment reduced from 60 days pre-intervention to 36 days in the post-intervention period across all sites (Incidence Rate Ratio 0.66, 95% CI 0.52 to 0.85) for up to 8 months post intervention without changes in other aspects of service delivery. Variation in waiting time was also reduced, suggesting a reduction in the ‘tail’ of patients previously classified as low priority waiting excessively long periods for assessment.

Discussion: Improvements in access for community outpatient services can be achieved by a relatively simple approach that creates protected assessment appointments for all patients based on analysis of service demand, rather than placing patients on a waitlist and triaging according to perceived urgency.


Biography: 

Project Officer, Eastern Health and La Trobe University

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