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Evaluating the Effectiveness of Access Improvement Strategies in a Multidisciplinary Memory Clinic

Demand for treatment services related to neuro-cognitive disorders (e.g. mild and major neuro-cognitive disorders with and without behavioral symptoms) is growing due to the aging of our population, increased life expectancy, and the high prevalence of cognitive symptoms. Since these disorders require both acute intervention and long-term care plans from collaborative disciplines (e.g. neurologist, geriatrician, psychiatrist, neuro-psychologist, social worker, speech therapist, physical therapist, care manager), demand for multidisciplinary memory clinics is also increasing rapidly. In the studied multidisciplinary memory disorders clinic with three disciplines, average monthly demand has increased by almost five times and average wait time of patients to receive their first evaluation has increased from 20 days to over two months between 2011 and 2017. Improving access and reducing wait time are challenging aims due to the variety of needs and services required, varying follow-up care needs, and complex patient preferences regarding scheduling because of the needs of their caregivers and guardians. In this paper, we address these challenges and develop an empirical simulation-optimization model to evaluate the effectiveness of access improvement strategies. Results suggest that despite the increasing wait times in the multidisciplinary memory clinic, increasing provider slots is not always an effective strategy. In fact, overbooking and reducing unnecessary follow-up visits can result in significant performance improvements.