Objective. To measure the relationship between time spent waiting for health care services and patients' mortality. Data Source. Data on the number of days until the next available appointment at 89 Veterans Affairs (VA) medical centers in 2001 were extracted from a VA administrative database. These facility-level data were merged with individual-level data for a sample of veterans who visited a VA geriatric outpatient clinic in 2001. The merged dataset includes facility-level data on waiting times and individual-level data on demographics, health status (e.g., diagnoses), and mortality. Study Design. This was a retrospective observational study using secondary data from administrative sources. The dependent variable was mortality within a 6-month follow-up period. The main explanatory variable of interest was VA facility-level wait times for outpatient visits measured in number of days. Random effects logistic regression models were risk adjusted for prior individual health status and facility-level differences in case mix. Principal Findings. Veterans who visited a VA medical center with facility-level wait times of 31 days or more had significantly higher odds of mortality (odds ratio 5 1.21, p 5 0.027) compared with veterans who visited a VA medical center with facility-level wait times of o31 days. Conclusions. Our findings support the largely 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 (e.g., physician reimbursement levels), the consequences of long waits in other populations, and effective policies to decrease long waits for health care services.
IMPORTANCE Primary care services based at home have the potential to reduce the likelihood of hospitalization among older adults with multiple chronic diseases. OBJECTIVE To characterize the association between enrollment in Home-Based Primary Care (HBPC), a national home care program operated by the US Department of Veterans Affairs (VA), and hospitalizations owing to an ambulatory care-sensitive condition among older veterans with diabetes mellitus.
In veterans with Type 2 diabetes, greater HbA variability was associated with an increased risk of adverse long-term outcomes, independently of HbA levels and direction of change. Limiting HbA fluctuations over time may reduce complications.
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