{
  "abstract": "Background: Post-hospital discharge primary care follow-up visits are associated with lower readmissions but may be underutilized. Limited structured data exist on clinic-, PCP-, and patient-level barriers encountered during scheduling.\n\nMethods: We implemented a quality improvement (QI) initiative with hospital operations and scheduling teams. Schedulers used a new in-house Epic SmartForm to document real-time barriers when scheduling post-discharge PCP follow-up. The SmartForm was refined through Plan-Do-Study-Act (PDSA) cycles to improve usability, barrier classification, and data reliability. SmartForm data were reviewed with interdisciplinary teams to guide scheduling interventions.\n\nResults: From August 2022 through October 2024, schedulers documented 13,823 SmartForm notes for 13,420 patients. Barriers were documented in 4,024 notes (29%), with 2,896 barrier notations after excluding “reason not listed.” The most common barriers were PCP availability constraints (46%), namely accommodation requests (30%); and patient-related reasons (42%), namely patients feeling the appointment was not needed (12%). These findings informed education on protected post-hospital follow-up slots and targeted outreach to clinic directors and staff.\n\nDiscussion: Barrier identification gave leadership clearer visibility into why timely post-discharge PCP follow-up was not being scheduled. PCP availability barriers directly informed education on protected follow-up slots and clinic outreach when accommodations were needed. Patient-related barriers suggested a need for stronger communication during discharge planning.\n\nConclusions: Embedding an in-house SmartForm within scheduler workflows and refining it through PDSA cycles enabled structured, real-time capture of scheduling barriers. Schedulers are key contributors to care transitions and systematic monitoring of barriers can support data-driven QI efforts to improve timely post-discharge PCP follow-up.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine UCLA Health"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Brian Le",
      "orcid": "0009-0003-7642-3202"
    },
    {
      "affs": [
        0
      ],
      "name": "Wendy Simon"
    },
    {
      "affs": [
        0
      ],
      "name": "Jessica Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jeri Robertson"
    },
    {
      "affs": [
        0
      ],
      "name": "Erin Dowling"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6zta1mjc1tt5r.bib",
  "cited_by": 0,
  "doi": "10.56305/001c.170605",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730607/?tool=EBI",
  "id": "6zta1mjc1tt5r",
  "issns": [
    "2994-5593"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13730607",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Quality Improvement"
    ],
    [
      "openalex",
      "1803|Healthcare Operations and Scheduling Optimization"
    ]
  ],
  "openalex": "W7225104863",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730607/pdf/?tool=EBI",
  "pmcid": "PMC13730607",
  "pmid": "42979343",
  "published": "2026-10-01",
  "publisher": "Department of Medicine of Alpert Medical School of Brown University",
  "ris": "https://research.draconitic.com/paper/6zta1mjc1tt5r.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:46Z",
      "native_id": "PMC:PMC13730607",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13730607"
    },
    {
      "first_seen": "2026-11-07T12:23:07Z",
      "native_id": "PMC13730607",
      "source": "pmc",
      "url": "https://doi.org/10.56305/001c.170605"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Collaborative Solutions to Identify Scheduling Barriers for Timely Post-Hospital Discharge Primary Care Follow-Up: A Quality Improvement Initiative",
  "title_text": "Collaborative Solutions to Identify Scheduling Barriers for Timely Post-Hospital Discharge Primary Care Follow-Up: A Quality Improvement Initiative",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:23:07Z",
  "url": "https://research.draconitic.com/paper/6zta1mjc1tt5r",
  "venue": "Journal of Brown hospital medicine",
  "versions": []
}