• Julia C Prentice, B Graeme Fincke, Donald R Miller, and Steven D Pizer.
• Department of Veterans Affairs, Center for Health Quality Outcomes and Economic Research, Boston University School of Public Health, 150 S Huntington Ave, Mail Stop 152H, Boston, MA 02130, USA. julia.prentice@va.gov
• Am J Manag Care. 2011 Feb 1; 17 (2): e43-54.

ObjectiveTo examine the relationship between glycated hemoglobin (A1C) levels and the number of days spent waiting for primary care appointments.Study DesignRetrospective observational study that relied on Department of Veterans Affairs (VA) utilization data and Medicare claims data from 2001 to 2003. The outcome was A1C levels. The main explanatory variable of interest was facility-level primary care wait times measured in days.MethodsHeckman selection models simultaneously predicted the presence of an A1C value and its level. Models were risk adjusted for prior individual health status. Separate models were estimated on the entire sample and on subsamples stratified by baseline A1C levels.ResultsVeterans who visited VA facilities with wait times of longer than 32.5 days had small significant increases in A1C levels of 0.14 percentage point for the whole sample, 0.07 percentage point for patients with baseline A1C levels less than 7%, 0.11 percentage point for patients with baseline A1C levels between 7% and 8%, and 0.18 percentage point for patients with baseline A1C levels greater than 8%.ConclusionsDecreasing wait times has the potential to reduce A1C levels by 0.18 percentage point for patients with baseline A1C levels exceeding 8%. This effect is roughly one-third of what is achieved with the most successful existing quality improvement strategies. Ensuring timely access to outpatient care could be an important addition to future diabetes care quality improvement programs.

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