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- Title
Effect of advanced access scheduling on processes and intermediate outcomes of diabetes care and utilization.
- Authors
Subramanian, Usha; Ackermann, Ronald T.; Brizendine, Edward J.; Saha, Chandan; Rosenman, Marc B.; Willis, Deanna R.; Marrero, David G.
- Abstract
<bold>Background: </bold>The impact of open access (OA) scheduling on chronic disease care and outcomes has not been studied.<bold>Objective: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
UNITED States; PEOPLE with diabetes; CHRONIC disease treatment; HEALTH facilities; HEALTH care industry; HEALTH outcome assessment; EVALUATION of medical care; MEDICAL care; HYPERTENSION; THERAPEUTICS; TYPE 2 diabetes treatment; CLINICS; COMPARATIVE studies; GLYCOSYLATED hemoglobin; LONGITUDINAL method; LOW density lipoproteins; MANAGED care programs; RESEARCH methodology; MEDICAL appointments; MEDICAL cooperation; PATIENT compliance; RESEARCH; RESEARCH funding; EVALUATION research; RETROSPECTIVE studies; PATIENTS' attitudes; ODDS ratio
- Publication
JGIM: Journal of General Internal Medicine, 2009, Vol 24, Issue 3, p327
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-008-0888-2