Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization
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The impact of open access (OA) scheduling on chronic disease care and outcomes has not been studied.
To assess the effect of OA implementation at 1 year on: (1) diabetes care processes (testing for A1c, LDL, and urine microalbumin), (2) intermediate outcomes of diabetes care (SBP, A1c, and LDL level), and (3) health-care utilization (ED visits, hospitalization, and outpatient visits).
We used a retrospective cohort study design to compare process and outcomes for 4,060 continuously enrolled adult patients with diabetes from six OA clinics and six control clinics. Using a generalized linear model framework, data were modeled with linear regression for continuous, logistic regression for dichotomous, and Poisson regression for utilization outcomes.
Patients in the OA clinics were older, with a higher percentage being African American (51% vs 34%) and on insulin. In multivariate analyses, for A1c testing, the odds ratio for African-American patients in OA clinics was 0.47 (CI: 0.29-0.77), compared to non-African Americans [OR 0.27 (CI: 0.21-0.36)]. For urine microablumin, the odds ratio for non-African Americans in OA clinics was 0.37 (CI: 0.17-0.81). At 1 year, in adjusted analyses, patients in OA clinics had significantly higher SBP (mean 6.4 mmHg, 95% CI 5.4 – 7.5). There were no differences by clinic type in any of the three health-care utilization outcomes.
OA scheduling was associated with worse processes of care and SBP at 1 year. OA clinic scheduling should be examined more critically in larger systems of care, multiple health-care settings, and/or in a randomized controlled trial.
KEY WORDSdiabetes open access process of care outcomes utilization
- 3.Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.Google Scholar
- 8.Murray M, Tantau C. Same-day appointments. Exploding the access paradigm. FPM. 2000;7:45–50.Google Scholar
- 9.Harkinson MT, Blumenfrucht FD. Sustained improvement for specialty clinic access. Jt Comm J Qual Patient Saf. 2006;32(3):142–51.Google Scholar
- 10.Schall MW, Duffy T, Krishnamurthy A, Levesque O, Mehta P, Murray M, et al. Improving patient access to the Veterans Health Administration’s primary and specialty care. Jt Comm J Qual Patient Saf. 2004;30(8):415–23.Google Scholar
- 16.Kerr EA, Gerzoff RB, Krein SL, et al. A comparison of diabetes care quality in the Veterans Affairs Healthcare System and commercial managed care: results from the TRIAD Study. Ann of Intern Med. 2004;141:272–81.Google Scholar
- 22.HEDIS. Health Plan Employer Data and Information Set. Washington, DC: National Committee for Quality Assurance; 1999.Google Scholar
- 29.National Committee for Quality Assurance, American Diabetes Association: Diabetes Quality Improvement Project Initial Measure Set (Final Version). Available at http://www.ncqa.org/dprp/dqip2.htm.
- 33.Kim C, Williamson DF, Mangione CM, Safford MM, Selby JV, Marrero DG, Curb JD, Thompson TJ, Narayan KM, Herman WH. Translating Research Into Action for Diabetes (TRIAD) Study. Managed care organization and the quality of diabetes care: the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care. 2004;27:1529–34.PubMedCrossRefGoogle Scholar
- 41.Breslow NE, Clayton DG. Approximate inference in generalized linear mixed models. JASA. 1993;88:125–34.Google Scholar
- 42.Saddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KM. A diabetes report card for the United States:quality of care in the 1990s. Ann Intern Med. 2002;136:565–74.Google Scholar
- 43.Brown AF, Gregg EW, Stevens MR, Karter AJ, Weinberger M, Safford MM, Gary TL, Caputo DA, Waitzfelder B, Kim C, Beckles GL. Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study. Multicenter Study. Diabetes Care. 2005;28(12):2864–70.PubMedCrossRefGoogle Scholar
- 47.Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA. 2002;287:2542–51.Google Scholar
- 50.Solberg LI, Maciosek MV, Sperl-Hillen JM, Crain LA, Engebreston KI, et al. Does improved access to care affect utilization and costs for patients with chronic conditions. Am J Mang Care. 2004;10:717–22.Google Scholar
- 53.Kerr EA, Smith DM, Hogan MH, et al. Comparing clinical automated, medical record and hybrid data sources for diabetes quality measures. Joint Comm J Qual Improv. 2002;28:555–65.Google Scholar
- 54.VA Office of Quality and Performance. 13 Feb 2001. Network Performance Measures Reports. http://vaww.oqp.med.va.gov/oqp_services/performance_measurement/reports.asp. Accessed 14 Apr 2003.
- 56.Tuncelli et al. Endocr Pract. 2006;12(4):380–7.Google Scholar