Delayed Access to Health Care and Mortality

Abstract

Objective. To measure the relationship between time spent waiting for health care services and patients' mortality. Data Source. Data on the number of days until the next available appointment at 89 Veterans Affairs (VA) medical centers in 2001 were extracted from a VA administrative database. These facility-level data were merged with individual-level data for a sample of veterans who visited a VA geriatric outpatient clinic in 2001. The merged dataset includes facility-level data on waiting times and individual-level data on demographics, health status (e.g., diagnoses), and mortality. Study Design. This was a retrospective observational study using secondary data from administrative sources. The dependent variable was mortality within a 6-month follow-up period. The main explanatory variable of interest was VA facility-level wait times for outpatient visits measured in number of days. Random effects logistic regression models were risk adjusted for prior individual health status and facility-level differences in case mix. Principal Findings. Veterans who visited a VA medical center with facility-level wait times of 31 days or more had significantly higher odds of mortality (odds ratio 5 1.21, p 5 0.027) compared with veterans who visited a VA medical center with facility-level wait times of o31 days. Conclusions. Our findings support the largely assumed association between long wait times for outpatient health care and negative health outcomes, such as mortality. Future research should focus on the causes of long waits for health care (e.g., physician reimbursement levels), the consequences of long waits in other populations, and effective policies to decrease long waits for health care services.

Medical Home Features of VHA Primary Care Clinics and Avoidable Hospitalizations

“…Avoidable hospitalizations may be particularly sensitive to measures of access to ambulatory care. 12,13 Another study of VHA primary care clinics found that elderly adults with diabetes experienced a 3 % higher odds of an ACSC hospitalization with a 10-day increase in appointment wait time. 14 This suggests that same day appointments, extended hours, and other access and scheduling components play a key role in improving acute, preventable outcomes.…”

Metrics That Matter

“…A common strategy to address this problem is to compute facility-level average metrics that exclude the individual patient whose outcome is being assessed. 8,[13][14][15][16][17][18] This is a similar approach to using an instrumental variable analysis that allows consistent estimation of relationships between explanatory variables and outcomes even when key explanatory variables are correlated with the error terms in the models.…”

“…These clinical outcomes are not likely to be related to metrics that fail to measure access and unmet health care needs. 8,[13][14][15][16][17][18] Two key lessons emerged from this validation work. First, different access metrics predicted satisfaction for different patient populations.…”

“…27 Models would need to be appropriately adjusted for case mix and there would be a lag in the ability to obtain these data, but we believe the advantages of using an independent data source outweigh its potential disadvantages. [13][14][15][16][17][18]27 Where it is not possible to rely on independent data, it is important to minimize the role that subjective judgments can play in the data-generating process. The most controversial metric in the VHA access crisis required schedulers to determine and enter the date on which a patient wanted to be seen for follow-up care.…”

Analysis of waiting time for elective surgical procedures in neurosurgery department at a tertiary care teaching hospital in NCT, India

“…Medical outcomes and patient satisfaction are to a great extent dependent on timely access and availability of services. 1 Timely accesses to services in healthcare are dependent on infrastructure, services, equipment and optimal use of these resources to meet the patient goals. In resource, constrained situation appropriate techniques of hospital management are to be utilized by administrators to provide timely access and availability of treatment.…”