Continuity of Care and Avoidable Hospitalizations for Chronic Obstructive Pulmonary Disease (COPD)

Abstract

Background: Numerous studied suggest that better continuity of care could result in better health outcomes. However, few studies have examined the relationship between continuity of care and avoidable hospitalizations.Methods: A retrospective cohort study design was adopted. We used secondary data analysis based on claim data regarding health care utilization under a universal coverage health insurance scheme in Tai

Effect of Continuity of Care on Emergency Department Visits in Elderly Patients with Asthma in Taiwan

“…In studies focusing on adults or older people, low-income status was found to be adversely associated with health outcomes. 22,23 Despite the insignificance of enrollment in the P4P program, the program seemed to be one of the factors reducing the risk of asthma-related ED visits in older patients with asthma (aHR, 0.78). A study reported that P4P programs benefit patients with diabetes and improve COC as well as health outcomes.…”

“…An inverse association was reported between COC and health outcomes, such as hospitalization and ED visits, among patients with COPD. 22,25 In addition, asthma-COPD overlap syndrome has been increasingly discussed recently because of the similar clinical features of asthma and COPD. 48 Therefore, our results support the theory that older patients with asthma and COPD have a higher risk of ED visits.…”

“…The CCI, which was calculated for each patient according to outpatient or inpatient care, was divided into 3 groups: 0, 1 to 2, and Ն3. 43 The number of ambulatory visits for asthma (4 -12, 13-24, and Ն25 times), 25,26,30 whether a patient was hospitalized for asthma, 24 and whether a patient had an ED visit for asthma 22,24,25 -all during the COC period-were used as proxies for disease severity.…”

“…35,40 -42 In addition, health status and disease severity may affect the measurement of health outcomes; therefore, we considered medical conditions in the previous year and in the COC period to identify patients' health status and disease severity. Furthermore, the Charlson Comorbidity Index (CCI) and a history of chronic obstructive pulmonary disease (COPD; ICD-9-CM codes 491, 492, or 496) 22 were included and identified in the previous year. The CCI, which was calculated for each patient according to outpatient or inpatient care, was divided into 3 groups: 0, 1 to 2, and Ն3.…”

“…19,20 Continuity of care (COC) is a process in which a patient and a medical team are cooperatively involved in ongoing health care management. Although studies have linked high COC to less hospitalization, 21,22 the relationship between COC and ED visits among aging adults remains unclear. Studies have ascribed better health care outcomes in chronic diseases, such as asthma, to high COC.…”