Journal of General Internal Medicine

, Volume 24, Issue 3, pp 327–333

Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization

  • Usha Subramanian
  • Ronald T. Ackermann
  • Edward J. Brizendine
  • Chandan Saha
  • Marc B. Rosenman
  • Deanna R. Willis
  • David G. Marrero
Original Article



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.


diabetes open access process of care outcomes utilization 


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Usha Subramanian
    • 1
    • 2
    • 3
    • 8
  • Ronald T. Ackermann
    • 2
    • 3
  • Edward J. Brizendine
    • 4
  • Chandan Saha
    • 4
  • Marc B. Rosenman
    • 3
    • 5
  • Deanna R. Willis
    • 6
  • David G. Marrero
    • 3
    • 7
  1. 1.Roudebush VAMCIndianapolisUSA
  2. 2.Division of General Internal Medicine and Geriatrics, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  3. 3.Regenstrief Institute for Healthcare, IncIndianapolisUSA
  4. 4.Division of Biostatistics, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  5. 5.Department of PediatricsIndiana University School of MedicineIndianapolisUSA
  6. 6.Department of Family MedicineIndianapolisUSA
  7. 7.Division of Endocrinology, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  8. 8.IF-122IndianapolisUSA

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