title: Does open access improve the process and outcome of podiatric care?
abstract: BACKGROUND
  Open access to clinics is a management strategy to improve healthcare delivery. Providers are sometimes hesitant to adopt open access because of fear of increased visits for potentially trivial complaints. We hypothesized open access clinics would result in decreased wait times, increased number of podiatry visits, fewer no shows, higher rates of acute care visits, and lower minor amputation rates over control clinics without open access.
  
  
  METHODS
  This study was a national retrospective case-control study of VHA (Veterans Hospital Administration) podiatry clinics in 2008. Eight case facilities reported to have open podiatry clinic access for at least one year were identified from an email survey. Sixteen control facilities with similar structural features (e.g., full time podiatrists, health tech, residency program, reconstructive foot surgery, vascular, and orthopedic surgery) were identified in the same geographic region as the case facilities.
  
  
  RESULTS
  Twenty-two percent of facilities responded to the survey. Fifty-four percent reported open access and 46% did not. There were no differences in facility or podiatry panel size, podiatry visits, or visit frequency between the cases and controls. Podiatry visits trended higher for control facilities but didn't reach statistical significance. Case facilities had more new consults seen within 30 days (96%, 89%; P = 0.050) and lower minor amputation rates (0.62/1,000, 1.0/1,000; P = 0.041).
  
  
  CONCLUSIONS
  The VHA is the worlds largest managed care organization and it relies on clinical efficiencies as one mechanism to improve the quality of care. Open access clinics had more timely access for new patients and lower rates of minor amputations.
authors.affiliation: Captain James A. Lovell Federal Health Care Center, North Chicago, IL, and Scholls Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine, North Chicago, IL, USA. jswrobel@med.umich.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Wrobel
authors.forename: Michael L
authors.initials: ML
authors.lastname: Davies
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Robbins