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

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Background: The impact of open access (OA) scheduling on chronic disease care and outcomes has not been studied. OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)327-333
Number of pages7
JournalJournal of general internal medicine
Volume24
Issue number3
DOIs
StatePublished - Mar 1 2009

Keywords

  • Diabetes
  • Open access
  • Outcomes
  • Process of care
  • Utilization

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of 'Effect of advanced access scheduling on processes and intermediate outcomes of diabetes care and utilization'. Together they form a unique fingerprint.

  • Cite this