Effects of continuity of care on hospital admission in patients with type 2 diabetes: analysis of nationwide insurance data

Abstract

BackgroundA system for managing chronic disease including diabetes mellitus based on primary care clinics has been used in Korea since April 2012. This system can reduce copayments for patients that are managed by a single primary-care provider and lead to improve continuity of care. The aim of this study is to determine whether there is an association between continuity of care for outpatients and hospital admission and identify the continuity index that best explains hospital admissions for patients with type 2 diabetes.MethodsWe performed a cross-sectional study using 2009 National Health Insurance Sample (NHIS) from the Health Insurance Review & Assessment Services (HIRA) of Korea. The dependent variable was hospital admission due to type 2 diabetes mellitus. Continuity of care was measured using the Usual Provider Care index (UPC), Continuity of Care index (COC), Sequential Continuity of Care index (SECON), and Integrated Continuity of Care index (ICOC).ResultsPatients with low COC scores (<0.75) were more likely to be hospitalized [odds ratio, 2.44; 95% CI, 2.17–2.75] compared with the reference group (COC ≥0.75), after adjusting for all covariates. we calculated the area under the receiver operating characteristic (AUROC) curve for each index to find which index had the greatest explanatory ability for hospital admission. The AUROC of the COC was the greatest (0.598), but the AUROC curves for the UPC (0.597), SECON (0.593), and ICOC (0.597) were similar.ConclusionsHigh continuity of care may reduce the likelihood for hospital admission. The COC had marginally more explanatory power.

Impact of Continuous Care on Health Outcomes and Cost for Type 2 Diabetes Mellitus: Analysis Using National Health Insurance Cohort Database

“…Severity of diabetes was not properly considered; this research instead applied the Charlson comorbidity score to consider the patient's overall health condition. In the study by Cho et al [30], the prescription of hypoglycemic agents (types and number) and comorbidity index together were used to consider the severity of the disease. In this study, prescriptions of hypoglycemic agents and comorbidity score were also considered to adjust for the severity of diabetes.…”

“…The characteristics of the medical institutions, such as types, ownership, number of beds, and number of physicians, were based on the most visited medical institutions during the continuity observation period. According to previous studies [28][29][30], the most visited medical institution was defined as the main medical institution during the continuity observation period. However, if there were medical institutions that had identical frequencies of visits in the same year, the most recently visited medical institution was defined as the main one.…”

Effect of continuity of care on health-related quality of life in adult patients with hypertension: a cohort study in China

“…The effects of continuity of care have been debated in previous studies because some have concluded that continuity of care is associated with fewer hospitalizations, emergency department visits, and hospital admissions [3–7]; low pharmaceutical expenditures and healthcare expenses [5, 8–10]; decreased mortality rates [11, 12]; fewer duplicated medications [13]; improved medication adherence [14]; and patient satisfaction [15–18]. However, others insist that high continuity of care may lead to the purchase of more drugs overall and that the effects on HRQoL are unclear; thus, these should be further examined [19, 20].…”

Utility of the Hospital Admission Risk Programme diabetes risk calculator in identifying patients with type 2 diabetes at risk of unplanned hospital presentations

“…The HARP tool was developed by the WestBay Alliance and Western HARP Consortium, and is based on the Chronic Condition Risk Calculator. For example, recently, an integrated primary-secondary model of care for the management of T2D that provided multidisciplinary specialist care in general practice was found to reduce potentially preventable diabetes-related hospital presentations to hospital by approximately half 16 and in addition, improved continuity of care 17 and a primary-care-based empowerment programme were also effective. In addition, dedicated services, such as the Victorian HARP, have been implemented that address the risk of hospitalisation in patients with chronic illness, through coordinating access to services and improving patients' capacity for self-care and maintenance of well-being.…”

“…Identifying the drivers of increased risk of unplanned presentation to hospital may lead to targeted education or treatment strategies designed to mitigate risk or referral into specific management pathways to access additional services. For example, recently, an integrated primary-secondary model of care for the management of T2D that provided multidisciplinary specialist care in general practice was found to reduce potentially preventable diabetes-related hospital presentations to hospital by approximately half 16 and in addition, improved continuity of care 17 and a primary-care-based empowerment programme were also effective. 18 Further research on the outcomes of patients with T2D following attendance at services recommended by the HARP tool, to determine their impact on reducing the risk of hospital presentation, would be of significant importance in assessing the utility of the HARP tool in preventing unplanned hospital presentations.…”