Provision of Extended Office Hours at the Usual Source of Care and its Effect on Healthcare Utilization and Expenditures in the Population of Adults with Chronic Ambulatory Care Sensitive Conditions

Abstract

Healthcare providers and policymakers are increasingly experimenting with innovations that decrease healthcare costs while maintaining or improving patient health. Enhancing timely access to primary care and maintaining continuity of care through the provision of extended office hours at the usual source of care holds promise for successful chronic disease management that improves chronic disease outcomes and reduces healthcare costs by limiting the need for acute healthcare services. Evidence suggests that the health gains and cost reductions might be greatest for patients with conditions that are primary care treatable or primary care preventable (ambulatory care sensitive conditions). Using nationally representative data from the Medical Expenditure Panel Survey, this dissertation examines trends in the provision of extended office hours at the usual source of care (USC) for US adults with and without chronic ambulatory care sensitive conditions and assesses the effects of these additional service hours on healthcare utilization and expenditures among US adults with a chronic ambulatory care sensitive condition (ACSC). The results of this dissertation indicate that the provision of extended office hours at the USC is associated with a reduction in total annual healthcare expenditures, emergency room utilization, inpatient utilization, and primary care utilization. However, despite these promising effects, only 1 in 4 US adults have a usual source of care that offers extended office hours and the provision of extended hours declined from 2005 to 2014. These findings are important for national efforts on improving chronic disease outcomes and reducing national healthcare expenditures. However, considering the additional staffing and overhead cost required to implement extended office hours, future studies should focus on determining the cost-effectiveness of the provision of extended office hours by the usual source of care.