Penchansky and Thomas's five dimensions of access, applied to the 212 attributed adults one composite practice never sees, carry this NU432 Unit 1 discussion post, replies included. Searches like "nu 432 unit 1 assignment example", "nu432 unit 1 sample" and "nu432 unit 1 example" land here.
Two Hundred Twelve Patients We Have Never Met: Reading an Attribution List Through Five Dimensions of Access
NU432 · Unit 1 Discussion
Posted by [Student Name]
Composite practice and figures written for a model post. No real patient or practice is described.
Initial Post
Our payer's attribution report lists 1,430 adults as our patients. Of those, 212 have not had a visit with us in 24 months. Most are under 50 and insured through a Medicaid managed care plan. It is tempting to read that as good news, healthy people with no reason to come in, but 38 of the 212 carry a diabetes or hypertension code from an emergency department visit. Some of them are not healthy; they are just not here.
Penchansky and Thomas defined access through five dimensions: availability, accessibility, accommodation, affordability and acceptability (Penchansky & Thomas, 1981). Our data give one finding under each.
Availability: we have openings most weeks, so supply is not the main barrier. Accessibility: the nearest bus stop is 0.8 miles away, a long walk in winter. Accommodation: our phone lines open 8:00 to 4:30, which matches no shift at the two warehouses that employ many of these patients, and same-day slots fill by 8:20. Affordability: the plan's copays are nominal, so cost is not the barrier here. Acceptability: we do not yet know; no one has asked them.
Accommodation deserves the most attention because it is the one dimension the practice controls outright. The change I would make first is an evening RN visit block, two evenings a week, bookable online. I considered a text reminder campaign instead, but reminders reach only people already on the schedule, and these 212 are not.
What would you change first for patients you have never seen?
Reply to a Classmate on a Rural Clinic
Your rural patients face distance, which is accessibility. Evening hours would not help much there. Bodenheimer and colleagues describe panel management and outreach by the care team as a building block of primary care, which might reach patients who cannot travel (Bodenheimer et al., 2014).
Reply to a Classmate on Telehealth
Telehealth could help with accommodation, but it depends on a phone with data and a private place to talk, which some of our warehouse workers may not have on a break. I would pair it with the evening block rather than rely on it alone (Penchansky & Thomas, 1981).
References
Bodenheimer, T., Ghorob, A., Willard-Grace, R., & Grumbach, K. (2014). The 10 building blocks of high-performing primary care. Annals of Family Medicine, 12(2), 166-171. https://doi.org/10.1370/afm.1616
Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19(2), 127-140. https://doi.org/10.1097/00005650-198102000-00001
How this NU432 Unit 1 example is structured
The argument runs from number to cause to choice. Paragraph one states the figure and refuses the easy reading, that unseen patients are simply healthy, by noting that 38 of the 212 carry a diabetes or hypertension code from an emergency visit. Each access dimension then gets two or three sentences built the same way: the barrier, the evidence for it from the practice's own data, and who it falls on. Accommodation, meaning hours, phones and scheduling rules, receives the most space because the practice controls it outright; affordability receives the least, since the plan's copays are nominal and cost is not the barrier here. The chosen change is argued against one alternative, a text reminder campaign, which reaches only people already on the schedule. Both replies extend a peer's point with one new source rather than agreeing.
Get an NU432 Unit 1 example written to your instructions
Attribution figures from a real practice are rarely shareable, so a composite set works just as well. Pair it with the question that opened your board and any reply rules posted for the thread, and a model post built around one access framework comes back within 24-48h, free on a first request. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU432 Unit 1 questions, answered
Is the Penchansky and Thomas framework still acceptable to cite?
It is, and it is usually cited as the origin of the five dimensions rather than as current evidence. Pair it with something recent, such as the patient-centered access framework Levesque and colleagues published in 2013 or a current study of appointment availability, so the post shows the idea has held up. If your prompt names a different model, use that one; the sample swaps frameworks easily.
Where would attribution data come from if the practice will not share it?
Most students do not have it, and a composite is the normal answer. Build the numbers from published rates, such as national figures on adults without a usual source of care, and label them as illustrative. The post in this sample brackets every practice figure for that reason. Invented numbers presented as a real clinic's data are a problem; labeled composites are standard coursework.
Does the post need to propose a solution?
Most access prompts ask for one, and a post that only describes barriers tends to feel unfinished. One change argued well beats several listed, because the reader can judge whether it fits the barrier you found. The sample picks evening nurse visits and explains why text reminders would miss the same people. Check the prompt wording, since some Unit 1 boards want analysis only.