Waiting times and hospitalizations for ambulatory care sensitive conditions
Long waits for health care are hypothesized to cause negative health outcomes due to delays in diagnosis and treatment. This study uses administrative data to examine the relationship between time spent waiting for outpatient care and the risk of hospitalization for an ambulatory care sensitive condition (ACSC). Data on the number of days until the next available appointment were extracted from Veterans Affairs (VA) medical centers. Two methodological issues arose. First, the simultaneous determination of individual health status and wait times due to medical triage was overcome by developing an exogenous wait time measure. Second, selection bias due to unobserved case mix differences was minimized by separating in time the sample selection period from the period when wait times and outcomes were measured. Exogenous facility-level wait time was the main variable of interest in a fixed effects stacked heteroskedastic probit regression model that predicted the probability of ACSC hospitalization in each month of a six-month period. There was a significant and positive relationship between facility-level wait times and the probability of experiencing an ACSC hospitalization, especially for facility-level wait times of 29 days or more. Further research is needed to replicate these findings in other populations and among those with different clinical histories. As well, policymakers and researchers need an improved understanding of the causes of long wait times and interventions to decrease wait times.
KeywordsAccess to care ACSC hospitalization Wait times
Salary support for Dr. Prentice was provided by a Health Services Research Fellowship from the Center for Health Quality, Outcomes and Economic Research in the Department of Veteran Affairs. Additional support was provided under Grant Nos. IIR-04-233-1 & IAD-06-112-3 from the Department of Veterans Affairs, Health Services Research & Development Service. The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs.
- Baar, B.: New patient montitor: data definitions. Veteran Health Administration Support Services Center (2005a)Google Scholar
- Baar, B.: Next available detail data: Data definitions. Veterans Health Administration Support Services Center (2005b)Google Scholar
- Gordon, P., Chin, M.: Achieving a New Standard in Primary Care for Low-income Populations: Case Studies of Redesign and Change Through a Learning Collaborative. pp. 17. The Commonwealth Fund, New York (2004)Google Scholar
- Greene, W.H.: Econometric Analysis, 2nd edn. Prentice Hall, Upper Saddle River (1993)Google Scholar
- Institute of Medicine (IOM): The Committee on the Quality of Health Care in America, Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine, Washington D.C. (2004)Google Scholar
- AHRQ: Quality indicators-guide to prevention quality indictors: hospital admission for ambulatory care sensitive conditions. Agency for Healthcare Research and Quality Rockville; AHRQ Pub No. 02-R0203 (2001)Google Scholar
- StataCorp. STATA (release 9.0) Statistical Software. StataCorp, College Station, TX (2005)Google Scholar
- United States Government Accounting Office (U.S. GAO): More national action needed to reduce waiting times, but some clinics have made progress. United States General Accounting Office. GAO-01–953, (2001)Google Scholar
- VanDeusen Lukas, C., Meterko, M., Mohr, D., Seibert, M.N.: The Implementation and Effectiveness of Advanced Clinic Access. Health Services Research and Development Management Decision and Research Center. Office of Research and Development, Department of Veteran Affairs, Boston (2004)Google Scholar
- Veterans Health Administration (VHA): Decision support office, “summary of active stop codes; Reference I.,” Washington D.C., 2004. [accessed on January 15, 2005]. Available at http://vaww.dss.med.va.gov/programdocs/pd_oident.asp