Increased Continuity of Care Associated with Decreased Hospital Care and Emergency Department Visits for Patients with Asthma

Abstract

The objective of this study was to determine the association between continuity of care and emergency room visits/hospital care for patients with asthma. A population-based study was conducted using administrative healthcare datasets obtained from Alberta Health and Wellness, Alberta, Canada. The 4-year study period extended from April 1, 1996 to March 31, 2000, and took place at the Palliser Health Region in Alberta, Canada, which has a population of 88,000 people. A population-based sample of 2774 patients, diagnosed with asthma between ages 5 and 45 with two or more office visits for asthma and who lived in the Palliser Health Region for 2 consecutive years during the study period, was studied. The main outcome measure was the association of continuity of care with hospitalizations and emergency room visits for patients with asthma. Continuity of care was the proportion of total physician visits made to the most frequently visited physician. High continuity of care was associated with a decreased risk of an emergency visit (OR = 0.24: 95% CI 0.19-0.29), number of emergency visits (RR = 0.37; 95% CI 0.32-0.42), decreased risk of number of hospitalizations (RR = 0.69; 95% CI 0.54-0.89), and total days in hospital (average difference = 0.77; 95% CI 0.63-0.95), but not with ever hospitalized. High continuity of care was associated with a 60%-75% reduction in emergency room visits and an approximate 25% reduction in number of hospitalizations in patients with asthma. Interventions to improve continuity of care could have the potential to improve care and reduce cost.

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

“…45 Studies have suggested an association of superior COC with fewer ED visits in different populations with asthma. 23,26,30,41,46 Our findings are consistent with those reported in a previous study focusing on children. 41 That study indicated that 42.3% of children with asthma had high COC (COCI ϭ 1), and those with medium or low COC had a higher risk of asthma-related ED visits (odds ratio, 1.21 and 1.38, respectively).…”

“…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.…”

“…The total number of physician visits (N) and the number of visits to a given physician (n i ) include ambulatory claims (including clinic or hospital physician visits) in the principal diagnosis (ICD-9-CM code 493.xx). We calculated COCI 37 Patients' educational level or household income may affect health care outcomes 6,23,38 ; the NHI claims data set does not provide this information. Hence, insurance premiums were used as a proxy for socioeconomic status.…”

“…Studies have ascribed better health care outcomes in chronic diseases, such as asthma, to high COC. [23][24][25][26] However, the effect of COC on aging populations with asthma has not yet been well explored.…”

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

“…[16][17][18] National outpatient non-attendance rates, which vary from 5% to 16%, are higher among younger patients and those in deprived areas 18 and unpublished data from London HIV clinics indicate that outpatient non-attendance for PLWH can be as high as 25%. Retaining HIV patients in care may also reduce emergency department visits and hospitalisation, 19,20 and the resultant financial costs.…”