title: Effect of advanced access scheduling on processes and intermediate outcomes of diabetes care and utilization.
abstract: BACKGROUND
  The impact of open access (OA) scheduling on chronic disease care and outcomes has not been studied.
  
  
  OBJECTIVE
  To assess the effect of OA implementation at 1 year on: (1) diabetes care processes (testing for A1c, LDL, and urine microalbumin), (2) intermediate outcomes of diabetes care (SBP, A1c, and LDL level), and (3) health-care utilization (ED visits, hospitalization, and outpatient visits).
  
  
  METHODS
  We used a retrospective cohort study design to compare process and outcomes for 4,060 continuously enrolled adult patients with diabetes from six OA clinics and six control clinics. Using a generalized linear model framework, data were modeled with linear regression for continuous, logistic regression for dichotomous, and Poisson regression for utilization outcomes.
  
  
  RESULTS
  Patients in the OA clinics were older, with a higher percentage being African American (51% vs 34%) and on insulin. In multivariate analyses, for A1c testing, the odds ratio for African-American patients in OA clinics was 0.47 (CI: 0.29-0.77), compared to non-African Americans [OR 0.27 (CI: 0.21-0.36)]. For urine microablumin, the odds ratio for non-African Americans in OA clinics was 0.37 (CI: 0.17-0.81). At 1 year, in adjusted analyses, patients in OA clinics had significantly higher SBP (mean 6.4 mmHg, 95% CI 5.4 - 7.5). There were no differences by clinic type in any of the three health-care utilization outcomes.
  
  
  CONCLUSIONS
  OA scheduling was associated with worse processes of care and SBP at 1 year. OA clinic scheduling should be examined more critically in larger systems of care, multiple health-care settings, and/or in a randomized controlled trial.
authors.affiliation: Roudebush VAMC, Indianapolis, IN, USA. usubrama@iupui.edu
authors.forename: Usha
authors.initials: U
authors.lastname: Subramanian
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Ackermann
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Brizendine
authors.forename: Chandan
authors.initials: C
authors.lastname: Saha
authors.forename: Marc B
authors.initials: MB
authors.lastname: Rosenman
authors.forename: Deanna R
authors.initials: DR
authors.lastname: Willis
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D012189:Retrospective Studies
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin