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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

1068 — Waiting for Health Care and Preventable Hospitalizations

Prentice JC (Health Care Financing and Economics (HCFE), Boston VA Health Care System), Pizer SD (HCFE, Boston VA HCS)

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 Veterans Affairs (VA) outpatient health care and the likelihood of experiencing a preventable hospitalization.

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 86 VA medical centers in 2001. These facility-level data were merged with individual-level data for a sample of veterans (n=33,538) who visited a VA geriatric outpatient clinic in 2001. Fixed effects probit models that included facility-level wait times for outpatient care, standard risk-adjustors for prior individual health status, and facility dummy variables predicted the likelihood of experiencing a preventable hospitalization in each month of a six-month follow-up period.

Results:
There was a significant and positive relationship between facility-level wait times and the probability of experiencing a preventable hospitalization, especially for facility-level wait times of 29 days or more.

Implications:
The significant relationship between waiting for outpatient care and preventable hospitalization is consistent with our previous work that found a significant positive relationship between waiting for outpatient care and mortality. Future research should focus on the causes of long waits for health care and determine 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 and establish current VA policy that 90% of veterans should be seen within 30 days of their appointment request. Further steps were taken to decrease wait times with the nationwide launch of the Advanced Clinic Access initiative. This research, which finds that longer waits are associated with poorer health outcomes, supports the current focus on implementing policies and procedures to decrease wait times. Decreasing waits for healthcare may result in avoided health complications and long-term cost savings.


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