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IAD 06-112 – HSR&D Study

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IAD 06-112
Outpatient Waiting Times, Outcomes, and Cost for VA Patients with Diabetes
Steven Daniel Pizer PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: September 2007 - September 2010

BACKGROUND/RATIONALE:
Policymakers have argued that long waits for healthcare will negatively impact health due to delays in diagnosis and treatment. Despite the assumed importance of wait times, little data exists on wait times because the VA is the only United States health care system to systematically collect information on wait times. Therefore, little research has examined the health and cost implications of waiting for health care and this innovative study begins to fill this gap.

OBJECTIVE(S):
This project will explain the variation within the VA in how long veterans wait for outpatient care with supply and demand characteristics, and examine the potential effects of waiting for outpatient care on health outcomes and health care cost. Using VA administrative data and other publicly available data, we will focus on four objectives:

Objective 1: Study and describe the variation in wait times for outpatient care throughout the VA.
Objective 2: Develop a statistical model that predicts wait times for outpatient care.
Objective 3: Estimate the relationship between waiting for outpatient care, outpatient utilization, and health outcomes for veterans with diabetes.
Objective 4: For veterans with diabetes, measure the impact on VA, Medicare, and Medicaid costs of differences in utilization and health outcomes attributable to differences in outpatient wait times.


METHODS:
This study uses existing administrative data to achieve its objectives. We will estimate statistical models using linked VA, publicly available Medicare and Medicaid data and geographic data. The first model will predict parent station wait times based on demand (e.g. number of veterans in an area) and supply (e.g. number of appointments) characteristics. The next models will examine if veterans with diabetes who visit parent stations with longer wait times are at greater risk for diabetic complications and mortality. The final model will examine the acute and long-term care cost implications of decreasing outpatient wait times.

FINDINGS/RESULTS:
Models indicate that both supply of appointments and demand for care respond to changes in waiting times. The principal determinant of supply of primary care visits is total available resources, but the evidence suggests that managers respond to changes in waiting times for primary care by shifting resources to and from other services. Compared to supply, demand for primary care appointments appears to be more sensitive to changes in waiting times. Outcome models find longer wait times are significant predictors of stroke for veterans aged 70-74, heart attack for veterans aged 75-79 and for mortality and ACSC hospitalization for veterans aged 80 or older. There is also a significant positive relationship between primary care wait times and hemoglobin A1c levels.

IMPACT:
Policymakers argue that long waits for healthcare adversely affect health due to delays in diagnosis and treatment. Very little research has examined the implications of waiting for health care because wait times data are not widely available. This study begins to fill the gap by identifying the causes and health effects of long wait times. VA managers should consider providing the chronically ill and elderly populations with priority access to care.

PUBLICATIONS:

Journal Articles

  1. Prentice JC, Graeme Fincke B, Miller DR, Pizer SD. Primary care and health outcomes among older patients with diabetes. Health services research. 2012 Feb 1; 47(1 Pt 1):46-67.
  2. Prentice JC, Fincke BG, Miller DR, Pizer SD. Outpatient wait time and diabetes care quality improvement. The American journal of managed care. 2011 Feb 1; 17(2):e43-54.
  3. Pizer SD, Frakt AB, Feldman R. Nothing for something? Estimating cost and value for beneficiaries from recent Medicare spending increases on HMO payments and drug benefits. International Journal of Health Care Finance and Economics. 2009 Mar 1; 9(1):59-81.
  4. Frakt AB, Pizer SD, Hendricks AM. Controlling prescription drug costs: regulation and the role of interest groups in Medicare and the Veterans Health Administration. Journal of Health Politics, Policy and Law. 2008 Dec 1; 33(6):1079-106.
Conference Presentations

  1. Prentice J, Pizer SD. Are VA Health Care Services rationed? Using VA Wait Times to Model Supply and Demand for VA Services. Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL.
  2. Prentice JP, Pizer SP. Why Do Some VA facilities Have Long Waits? Poster session presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.


DRA: Health Systems, Diabetes and Related Disorders
DRE: Treatment - Comparative Effectiveness
Keywords: Cost, Cost-Effectiveness, Diabetes, Outcomes - Patient, Quality assessment, Quality Improvement, Utilization, Utilization patterns
MeSH Terms: none

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