![]() ![]() ![]() At our academic fertility center, Penn Fertility Care, which accommodates more than 3,000 new-patient visits (NPVs) annually, we observed two challenges to initiating treatment: (1) delayed access due to high demand, and (2) difficulties related to completing multiple diagnostic tests for both partners. 3 Fertility treatments are time-sensitive because each missed ovulatory cycle results in a setback by 1 month. 12 - 14 Among patients who discontinue in vitro fertilization treatment, stress is cited as the most common reason (39%), driven by the impact on the couple’s relationship and the anxiety or depression associated with the experience. 11 At that point, additional delays add to the anxiety and stress associated with this diagnosis. Patients with infertility have typically waited months to years before seeking medical care. 6 - 9 Both male and female factors contribute equally to infertility, and complex and time-consuming diagnostic workup in both partners often adds to the distress associated with this process. 5 Compared to other developed countries, the unmet demand for fertility services in the United States is high and projected to increase with expansion of insurance coverage and delayed childbearing such increased demand is expected to outpace the current workforce. In addition to financial and psychological factors, 3, 4 organizational and clinic-related factors also contribute to the reasons for discontinuation. 2 Also, in the United States, fertility treatment discontinuation rates are up to 65%. 1 In the United States, access to care is limited in part due to the wide variation in insurance coverage and considerable out-of-pocket costs associated with fertility care. This innovative care delivery model optimizes both personalization (which is essential for identifying and engaging with diverse patients) and standardization (which facilitates an effective intake process using the APP-physician model).Īpproximately 15% of reproductive-aged couples worldwide experience infertility, which is classified as a disease by the World Health Organization. Patient engagement via a semi-automated platform is not a replacement for human contact but is an efficient extender of certain approaches and activities that are personnel-intensive. ![]() The Fast Track to Fertility care delivery model was grounded in patient needs related to diagnostic workup that could be served by semi-automation. Pilot phases and iterative processes (using a fake back end to test mockups and configurations and developing comprehensive content for the texting platform) were crucial to building a robust framework prior to scaling the pathway. This care delivery model is novel, as we created a digital front door to improve access to fertility care including: (1) a telehealth new-patient visit with an advanced practice provider (APP), and (2) an artificial intelligence–augmented text-messaging platform to shorten the time to completion of a complex diagnostic workup. The addition of educational materials and anticipatory guidance via text contributed to increased patient engagement (to 80% from 60%) and high satisfaction scores (measured by Net Promoter Scores greater than 70). The redesigned model increased annualized new patient access by 23.8% (to 5,570 from 4,500) and decreased the time to initiation of treatment by approximately 50% (to 41 days from 97 days). Penn Medicine initially used a fake back-end texting platform (to test and authenticate various iterations) and then transitioned to an artificial intelligence–augmented semi-automation approach to facilitate timely completion of the workup. Advanced practice providers conducted new-patient visits via telehealth, and patients were offered enrollment in a texting platform to assist with completion of a complex workup for both partners. In August 2019, Penn Medicine began developing Fast Track to Fertility, a novel model of care delivery to improve access to fertility care and decrease time to completion of fertility workup and, by June 2021, deployed division-wide implementation of the new care model. Couples with infertility experience psychological distress associated with the prolonged period of recognizing a need for fertility assistance and the long journey of evaluation and management. ![]()
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