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RRP 06-180 – HSR&D Study

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RRP 06-180
Potential Barriers to Quality Care: Linking Wait Times to Avoidable Hospitalizations
Ann M. Borzecki MD MPH
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Bedford, MA
Funding Period: October 2006 - March 2007

BACKGROUND/RATIONALE:
There is ongoing concern regarding delayed access to care and long wait times for VA specialty and primary care clinics. To ensure timely access to care, the VA established a goal that all non-urgent appointments be scheduled within 30 days of request by 1998 and tracks this information centrally. As of 2001, over 50% of clinics were still not achieving this standard. While long wait times and delayed access to care are presumed to adversely affect health outcomes, the actual impact on patient outcomes is unknown.

OBJECTIVE(S):
Specific study objectives are to: 1) Examine rates of preventable hospitalizations across facilities as measured using the Agency for Healthcare Research and Quality prevention quality indicators (PQIs). 2) Collaborate with key VA stakeholders to ensure and promote policy-relevant questions and methodological design. 3) Examine the association between facility wait times at primary care and specialty care clinics and risk-adjusted PQI rates. 4) Determine whether similar relationships hold between wait times and other outcomes - mortality rates, admission rates, and urgent care and emergency room visits, select EPRP performance measures. 5) Develop and disseminate reports of findings to individual facilities.

METHODS:
This will be a retrospective observational study using existing databases. Our study sample will consist of veterans who received outpatient health care services from the VA during FY04 through the end of FY05. Wait time, defined as the time between when an appointment is requested and scheduled, will be obtained from the VA's KLF menu extracts. Data on outpatient and inpatient health care service use will be obtained from the VA's National Patient Care Database (NPCD), supplemented by Medicare inpatient and outpatient files in the case of dual enrollees. Vital status will be obtained from the NPCD, and the VA's Beneficiary Identification Records Locator Subsystem (BIRLS) death file, and information on selected clinical performance measures from External Peer Review Program data.

The dependent variable in all analyses is defined as average facility wait time during the first 6 months of FY05. Wait times will be aggregated by relevant clinic at the facility level. We will examine the association between facility wait times and patient outcomes also aggregated at the facility level over the subsequent 6 months. Our main outcomes will be separate and combined rates of PQIs, measured as number of hospital admissions for conditions including pneumonia, dehydration, urinary tract infection, perforated appendix, angina without procedure, congestive heart failure, hypertension, adult asthma, chronic obstructive pulmonary disease, diabetes complications, uncontrolled diabetes, and lower-extremity amputation among diabetes patients. Secondary outcomes will include mortality rates, admission rates, a combined rate of urgent care and emergency room visits and receipt of screening tests and achievement of target clinic outcomes for select chronic diseases.

Upon analyses completion, we will work with VA stakeholders and quality improvement (QI) staff at select facilities to develop facility-level reports that include information on facility-specific PQI rates, benchmarking to other facilities and associations between their facility's waiting times and PQI rates. We will then feed back these reports to the QI and other appropriate staff at each facility.

FINDINGS/RESULTS:
There are no findings at this time.

IMPACT:
If longer wait times increase the risk of adverse patient outcomes such as preventable hospitalizations, this will provide evidence for the need for additional system restructuring to decrease wait times to improve the health of our nation's veterans.




PUBLICATIONS:

Conference Presentations

  1. Borzecki AM, Chew PW, Loveland S, Loya PM, Rosen AK. Inpatient Quality Indicators Rates in Special VA Populations. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 13; Baltimore, MD.


DRA: Health Systems
DRE: none
Keywords: Access, Utilization patterns
MeSH Terms: none

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