Presented in 9th Annual Conference on the Science of Dissemination and Implementation


We are partnering with community health centers (CHCs) and their patients to redesign systems to deliver timely care to underserved populations in Indiana. Our Delphi study was designed to address two questions: 1) what solutions (e.g. organizational factors, processes, procedures) serve as facilitators to accessing care?; and 2) what organizational strategies might work to implement solutions in CHC environments?


We used a modified Delphi method, bringing experts together in one room for a face-to-face meeting to prioritize solutions for reducing access barriers and strategies to implement the solutions. We invited clinicians, operational leaders, staff and patients to participate. Including patients, rarely done with underserved populations, required us to modify the traditional Delphi method. Mailing multiple rounds of surveys was unlikely to give us the robust feedback from patients due to the transient nature of this population and potential to not understand the materials. Our modified Delphi approach, which included a patient orientation session, allowed patients to participate as equals among other experts.


We invited 46 experts from across Indiana. Thirty-six attended the event but only 33 voted (11 patients). We aggregated a list of 39 solutions and 8 implementation strategies from 89 key informant interviews of CHC patients, staff, clinicians and administrators completed in an earlier phase of our study. Delphi participants contributed an additional 11 solutions and 3 strategies that were included in the ranking activity.

After three rounds of ranking:
Top ten solutions for improving access to care: 1) ‘Modified Open Access' scheduling; 2) Reduced costs for uninsured patients; 3) Extended hours; 4) Enhanced customer service; 5) Offer dental services; 6) Coordinated follow-up care; 7) ‘Walk-in” urgent care; 8) Improved telephone process; 9) Enhancement to Medicaid; 10) Lower cost insurance.
Top five operational strategies: 1) Form a planning team; 2) Develop an assessment plan; 3) Communication with staff; 4) Communication with patients and community; 5) Team-based care.

Implications for D&I Research:

Others working with CHCs to change health care delivery may find the emergent prioritized lists useful. We used to these findings to shape the intervention offered in the final phase of our larger study currently underway in three intervention CHCs.

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