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.
Am J Manag Care. 2011 Feb 1;17(2):e43-54.
To examine the relationship between glycated hemoglobin (A1C) levels and the number of days spent waiting for primary care appointments.
Retrospective 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.
Heckman 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.
Veterans 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%.
Decreasing 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.
研究糖化血红蛋白（A1C）水平与等待初级保健预约天数之间的关系。
这是一项回顾性观察性研究，依赖于 2001 年至 2003 年期间退伍军人事务部（VA）利用数据和医疗保险索赔数据。结果是 A1C 水平。主要感兴趣的解释变量是按天测量的机构级初级保健等待时间。
Heckman 选择模型同时预测 A1C 值的存在及其水平。模型针对先前的个体健康状况进行了风险调整。在整个样本和按基线 A1C 水平分层的子样本上分别估计了单独的模型。
在等待时间超过 32.5 天的 VA 设施就诊的退伍军人 A1C 水平平均升高 0.14 个百分点，整个样本升高 0.14 个百分点，基线 A1C 水平低于 7%的患者升高 0.07 个百分点，基线 A1C 水平在 7%至 8%之间的患者升高 0.11 个百分点，基线 A1C 水平大于 8%的患者升高 0.18 个百分点。
对于基线 A1C 水平超过 8%的患者，将等待时间缩短 0.18 个百分点，就有可能降低 A1C 水平。这一效果约为现有最成功的质量改进策略所达到效果的三分之一。确保及时获得门诊护理可能是未来糖尿病护理质量改进计划的一个重要补充。
