Risk-Based Coordinated Scheduling (RCS) of healthcare interactions is required to address systemic health inequity, health system function and to improve patient outcomes. 

The goal of any healthcare system is to improve patient outcomes and overall public health. Unfortunately, significant disparities remain in accessing and implementing care in populations that are at highest risk for adverse outcomes. Lessons learned from the recent COVID-19 pandemic shows that our acute healthcare systems are fragile and can be easily overburdened. In the absence of addressing significant persistent systemic health inequities, healthcare systems will continue to experience significant burdens with regards to emergency room utilization, hospital admissions, and critical care services.

Appropriate and timely access to health services and care for those who require it most remains suboptimal with significant effects on health outcomes leading to unnecessary morbidity and mortality and over-utilization of expensive acute care services.

Studies continue to show that the uptake of evidence-based therapies to improve health outcomes is also suboptimal, particularly in socioeconomically disadvantaged populations.  Even in more affluent communities, the aging population, and associated increased comorbidity levels, require improved strategies to ensure evidence-based therapies are maximally implemented. 

Risk-based coordinated scheduling (RCS) is required to address persistent health inequities and optimal treatment uptake across all populations, in both acute and chronic illness management. The strategy of incorporating standardized individualized risk scores to determine appropriate site, immediacy and frequency of healthcare interactions and interventions will allow more appropriate resource allocation to affect positive outcomes. This will ultimately improve overall public health and health system function.

For decades, the traditional practice of outpatient medicine has created siloed care with patients visiting multiple different physicians at different sites, each focused on isolated components of care creating significant challenges in appropriate communication and coordination of care.

This can often lead to duplication of investigation and services leading to extra expense to patients with multiple and often excess isolated interactions within the outpatient healthcare system, that are often poorly coordinated to the detriment of the wholistic management of patients. This affects patients with multiple co-morbidities disproportionately. It also is inefficient from a time perspective, particularly for patients with multiple providers. Patients often need to book follow up to clarify things between providers and delay the implementation of plans pending review amongst all care providers.

Not all individuals being treated for derangement in a specific physiological system have the same risk of a poor outcome because of their specific disease condition.  In addition, many patients have multiple vascular-related co-morbidities (cardiac, renal, endocrine etc.) that can markedly elevate their risk for a poor outcome. However, patients with similar comorbidity system categories may have markedly different overall risks for a poor outcome, including emergency room use, hospitalization, or death. Very often patients with multiple comorbidities can deteriorate in between interactions with healthcare providers and end up in emergency rooms, requiring hospital admission, and incurring significant personal costs, as well as costs to the healthcare system. These patients often are scheduled to see their outpatient healthcare providers in a non-standardized way that depend on numerous factors unrelated to patients needs. These include, but are not limited to, physician patient load, office schedules and/or limited bookings available, patient waiting lists, physician vacation times and physician hospital- based responsibilities that make them unavailable for outpatient care.  

If we are truly interested in improving outcomes for complex patients who are at the highest risk of emergency room and acute care utilization, there must be a shift in focus to individualized risk-based coordinated scheduling (RCS) of interactions in the outpatient healthcare setting focusing on continuity and coordination of care. This strategy has great potential to improve cost effectiveness of the finite resources in healthcare systems as well. Tailoring resources and care to individualized patient risks is necessary to improve equitable and inclusive access to care within communities.

Currently, there is no standardized way to assess the patient’s total overall risk nor individual physiologic system risk for a poor outcome to determine priority system assessments. It is our position that using both standardized total overall risk and system specific risks to guide the scheduling of interactions with healthcare providers will optimally direct resources to those who would benefit the most from them.