The backlog that needs to be reduced consists of patients waiting to be scheduled or patients whose appointments have been put off into the future. Often in primary care, the backlog consists of patients waiting for physicals, new patient visits, or follow-ups. In specialty care, the backlog includes patients waiting for an initial consult with the specialist, or awaiting a timely return visit.  There are two important ways to measure the extent of the backlog:

• The third next available appointment is the average length of time in days between the day a patient makes a request for an appointment with a physician and the third next available appointment for that appointment — whether it is a new patient physical, routine exam, or return visit exam — without using “frozen” or held appointment slots. The “third next available” appointment is used rather than the “next available” appointment since it is a more sensitive reflection of true appointment availability. For example, an appointment may be open at the time of a request because of a cancellation or other unexpected event. Using the third next available appointment eliminates these chance occurrences from the measure of availability. This helps determine where availability on the schedule begins. Detailed information on how to measure the third next available appointment is available in the Measures section.
  
  
• Count the number of backlog appointments: Many groups have counted the number of backlog appointments (i.e., work the practice pushes into the future) by reviewing the future schedules and actually counting the number of appointments that represent backlog. Add the number of patients on a wait list to that count to get the total number of backlog appointments.