Improving Healthcare Systems for Access to Care and Efficiency by Underserved Patients

Principal Investigator

Bradley Doebbeling, BS, MD, MS


Indiana University- Purdue University at Indianapolis

Funding Announcement

Improving Healthcare Systems



Requested Project Budget*


Year Awarded


Project Period*

3 years

Project Summary

Background: Research has shown that access to health care is a major problem in the United States. In 2007, one in 10 adults reported that they either delayed or did not receive needed health care due to financial or insurance reasons. People confront many other barriers to access, in addition to financial barriers. Despite recent changes to policy and efforts to improve efficiencies, there are still widespread problems with accessing health care in Indiana Community Health Clinics (CHCs). In this research project, we are focused on helping underinsured people in Indiana overcome barriers to gaining access to care at CHCs. Our Indiana Access Collaborative is comprised of Indiana CHCs; CHC patients; the Indiana Primary Healthcare Association; MDwise, Inc.; and interdisciplinary researchers who are all working together to improve the situation for underserved patients.

Objectives: Our primary goal is to help develop procedures to help underinsured people efficiently and effectively get the care they need for common health problems. Our study questions are:

1. What are effective, patient-centered, system strategies to reduce barriers of availability, accommodation, and affordability to care?

2. Will expert panels and simulation modeling of proposed innovative policies help identify and prioritize the most feasible and impactful approaches to improve access?

3. Will implementing patient-centered, system redesign approaches identified above improve access in intervention CHCs more than in comparison clinics?

Methods: We will conduct the project in seven of eight CHCs that have volunteered to participate. We will interview patients, staff, and providers at these CHCs in order to better understand the barriers, challenges, and successful strategies that are used to get needed health care. We will organize the interview findings into categories that will be formally reviewed, added to, and prioritized by a panel of patients, healthcare providers, and experts. We will then use simulation (a systems engineering method) to model the way patients are enrolled in healthcare plans and scheduled for appointments to test alternatives and identify strategies for improving these processes. Finally, we will implement the new strategies in four of our partner CHCs and compare efficiency and satisfaction. We will train, coach, and monitor our partner CHCs’ efforts to develop and continually improve access to care for their patients.

Patient Outcomes (Projected): Many patients share the concern: “Will I be able to get the care I need if I become ill?” Because our team is a collaborative of patients and stakeholders in Indiana, we anticipate the proposed project will have an immediate impact on access. Expected patient outcomes are increased satisfaction, access, and engagement due to streamlined enrollment and appointment scheduling. Systems will be able to efficiently enroll patients in healthcare plans and prevent emergency room visits and avoid long waits at clinics.

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

PCORI Funding Awards

PCORI has approved 279 awards totaling more than $464.4 million to fund patient-centered comparative clinical effectiveness research projects to date.

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