The Effect of Continuity of Care on Emergency Room Use for Diabetic Patients Varies by Disease Severity

Abstract

BackgroundAlthough many studies have reported that high-quality continuity of care (COC) is associated with improved patient outcomes for patients with diabetes, few studies have investigated whether this positive effect of COC depends on the level of diabetes severity.MethodsA total of 3781 newly diagnosed diabetic patients selected from the 2005 National Health Insurance database were evaluated for the period 2005–2011. Generalized estimating equations combined with negative binomial estimation were used to determine the influence of COC on the overall emergency room (ER) use and diabetes mellitus (DM)-specific ER use. Analyses were stratified according to diabetes severity (measured using the Diabetes Complications Severity Index [DCSI]), comorbidities (measured using the Charlson comorbidity score), and age.ResultsCOC effects varied according to diabetes severity. Stratified analysis showed that the positive effect of COC on DM-specific ER use was the highest for a DCSI of 0 (least severe), with an incidence rate ratio (IRR) of 0.49 (95% CI, 0.41–0.59) in the high-COC group (reference group: low-COC group). Compared with the low-COC group, high-quality COC had a significant beneficial effect on overall ER use in younger patients (IRR 0.51; 95% CI, 0.39–0.66 for the youngest [18–40 years] group, and IRR 0.67; 95% CI, 0.59–0.76 for the oldest [>65 years] group) and those with a high number of comorbidities.ConclusionsThe positive effects of high-quality COC on the treatment outcomes of patient with diabetes, based on the overall and DM-specific ER use, depends on the level of disease severity. Therefore, providing health education to enhance high-quality COC when the disease severity is low may be critical for ensuring optimal positive effects during diabetes disease progression.

Continuity of Care and the Quality of Life among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Taiwan

“…Around 25% of patients with diabetes (especially those with comorbidities) may encounter difficulties obtaining CoC, mainly due to the severity of the disease. The inability to see a specific physician or maintain relational continuity with medical providers directly affects patients’ QoL [ 43 ]. Improving the QoL of patients with diabetes requires strengthening their CoC, understanding patients’ expectations and care requirements, and providing disease-related information and emotional support to inspire confidence about follow-up care after discharge, achieve effective disease management, and improve disease outcomes [ 22 , 41 , 42 ].…”

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

“…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.…”

Continuity of care evaluation: The view of patients and professionals about urban family physician program

“…[ 1 2 3 ] A good COC has been reported to be associated with increased use of preventive health services,[ 4 5 ] fewer hospitalization rate, fewer emergency department visit, and improved health care outcome. [ 6 ] In addition, numerous studies examined its effect to prevent several chronic diseases,[ 7 ] positive consequences in weight control, diabetes,[ 8 ] and their mortality. [ 9 ] Several additional studies have proved that better COC is associated with improved patient-physician relationship, patient satisfaction,[ 10 ] physician satisfaction and reduced health care cost.…”