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Outpatient wait time and diabetes care quality improvement
Julia C Prentice1, B Graeme Fincke, Donald R Miller
1Department of Veterans Affairs, Center for Health Quality Outcomes and Economic Research, Boston University School of Public Health, 150 S Huntington Ave, Mail Stop 152H, Boston, MA 02130, USA. julia.prentice@va.gov
The American Journal of Managed Care
|April 9, 2011
Summary
Longer primary care wait times are linked to increased glycated hemoglobin (A1C) levels in veterans. Reducing wait times may improve diabetes management and reduce A1C for patients with high baseline levels.
Area of Science:
- Health Services Research
- Diabetes Management
- Health Outcomes
Background:
- Glycated hemoglobin (A1C) is a key indicator of long-term glycemic control in diabetes.
- Timely access to primary care is crucial for effective chronic disease management.
- Previous research has not fully explored the direct impact of primary care wait times on A1C levels.
Purpose of the Study:
- To investigate the association between primary care appointment wait times and glycated hemoglobin (A1C) levels.
- To quantify the impact of extended wait times on glycemic control in a veteran population.
Main Methods:
- Retrospective observational study using Department of Veterans Affairs (VA) and Medicare data (2001-2003).
- Primary care wait times (days) were the main explanatory variable; A1C levels were the outcome.
- Heckman selection models were used, adjusting for individual health status.
Main Results:
- Veterans facing wait times over 32.5 days showed small but significant increases in A1C.
- A 0.18 percentage point A1C increase was observed for patients with baseline A1C > 8% with longer waits.
- The magnitude of A1C increase varied across different baseline A1C strata.
Conclusions:
- Reducing primary care wait times can potentially lower A1C levels, particularly for patients with poorly controlled diabetes.
- The impact of reduced wait times on A1C is comparable to established quality improvement strategies.
- Improving timely access to outpatient care is a viable strategy for diabetes quality improvement programs.
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