Kyoung Hee Cho1, Chung Mo Nam2, Young Choi1, Jae-Woo Choi1, Seon-Heui Lee3, Eun-Cheol Park4. 1. Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea. 2. Department of Biostatistics, College of Medicine, Yonsei University, South Korea. 3. Department of Nursing Science, College of Nursing, Gachon University, Incheon, South Korea. 4. Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Abstract
OBJECTIVE: To determine whether patients with greater continuity of care (COC) have fewer preventable hospitalizations. DESIGN: We conducted a cohort study using a stratified random sample of Korean National Health Insurance enrollees from 2002 to 2010. The COC index was calculated for each year post-diagnosis based on ambulatory care visits. We performed a recurrent event survival analysis via Cox proportional hazard regression analysis of preventable hospitalizations. STUDY PARTICIPANTS: A total of 5163 patients newly diagnosed with type 2 diabetes mellitus in 2003-6 and receiving oral hypoglycemic medication. MAIN OUTCOME MEASURE: Preventable hospitalization. RESULTS: Of 5163 eligible participants, 6.4% (n = 328) experienced a preventable hospitalization during the study period. The adjusted hazard ratio (HR) was 8.69 (95% CI, 2.62-28.83) for subjects with a COC score of 0.00-0.19, 7.03 (95% CI, 4.50-10.96) for those with a score of 0.20-0.39, 3.01 (95% CI, 2.06-4.40) for those with a score of 0.40-059, 4.42 (95% CI, 3.04-6.42) for those with a score of 0.60-0.79 and 5.82 (95% CI, 3.87-8.75) for those with a score of 0.80-0.99. The difference in cumulative incidence of preventable hospitalizations in patients with COC scores of 0.00-0.19 relative to those with COC scores of 1.00 was the greatest, at 0.97% points. CONCLUSIONS: Greater COC was associated with fewer preventable hospitalizations in subjects with type 2 diabetes.
OBJECTIVE: To determine whether patients with greater continuity of care (COC) have fewer preventable hospitalizations. DESIGN: We conducted a cohort study using a stratified random sample of Korean National Health Insurance enrollees from 2002 to 2010. The COC index was calculated for each year post-diagnosis based on ambulatory care visits. We performed a recurrent event survival analysis via Cox proportional hazard regression analysis of preventable hospitalizations. STUDY PARTICIPANTS: A total of 5163 patients newly diagnosed with type 2 diabetes mellitus in 2003-6 and receiving oral hypoglycemic medication. MAIN OUTCOME MEASURE: Preventable hospitalization. RESULTS: Of 5163 eligible participants, 6.4% (n = 328) experienced a preventable hospitalization during the study period. The adjusted hazard ratio (HR) was 8.69 (95% CI, 2.62-28.83) for subjects with a COC score of 0.00-0.19, 7.03 (95% CI, 4.50-10.96) for those with a score of 0.20-0.39, 3.01 (95% CI, 2.06-4.40) for those with a score of 0.40-059, 4.42 (95% CI, 3.04-6.42) for those with a score of 0.60-0.79 and 5.82 (95% CI, 3.87-8.75) for those with a score of 0.80-0.99. The difference in cumulative incidence of preventable hospitalizations in patients with COC scores of 0.00-0.19 relative to those with COC scores of 1.00 was the greatest, at 0.97% points. CONCLUSIONS: Greater COC was associated with fewer preventable hospitalizations in subjects with type 2 diabetes.