Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1022 — Delayed Access to Health Care and Mortality

Author List:
Prentice JC (Center for Health Quality, Outcomes and Economic Research)
Pizer SD (Health Care Financing and Economics; VA Boston Health Care System)

Objectives:
Policymakers argue it is essential to decrease waits for health care because delays in diagnosis and treatment are assumed to negatively affect individual health. Yet, little research has tested this assumption. This study examines the relationship between waiting for VA outpatient health care and patients’ mortality.

Methods:
Waiting for outpatient care is defined as the number of days between the appointment request and the day the next available appointment can be scheduled. Facility-level data on the average wait by clinic stop were extracted for 89 Veterans Affairs (VA) medical centers in 2001. These facility-level data were merged with individual-level data for a sample of veterans (n=37,489) who visited a VA geriatric outpatient clinic in 2001. Logistic regression models that included 1) facility-level wait times for outpatient care, 2) standard risk-adjustors for prior individual health status and 3) facility-level differences in case-mix predicted the odds of dying within a six-month follow-up period.

Results:
Veterans who visited a VA medical center with facility-level wait times of 28 days or more had significantly higher odds of mortality (odds ratio=1.17, p=0.024) compared to veterans who visited a VA medical center with facility-level wait times of 28 days or less.

Implications:
Our findings support the widely 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, the consequences of these long waits on other health outcomes (e.g. preventable hospitalizations) and effective policies to decrease long waits for health care services.

Impacts:
Low patient satisfaction originally led VA policymakers to monitor how long veterans wait for VA care. However, long waits for care also have a negative health impact. These wait time analyses can play a critical role in evaluating the current VA policy that 90% of veterans should be seen within 30 days of their appointment request.