Continuity of diabetes care is associated with avoidable hospitalizations: Evidence from Taiwan's National Health Insurance scheme
Journal
International Journal for Quality in Health Care
Journal Volume
22
Journal Issue
1
Pages
3/8
Date Issued
2009
Author(s)
Abstract
Objective: Taiwan's health-care system allows patients to utilize specialty services without referrals by primary care providers. This discontinuity of care may lead to increases in future hospitalizations. This study aims to determine whether the disconti- nuity of care is associated with the risk of hospitalization. Design: A secondary data analysis based on a claim data of a nationally representative random sample of diabetic patients in Taiwan. A usual provider continuity (UPC) index was developed-a ratio of the visits to the physician that subjects most usually see relevant to diabetes care to the total physician visits relevant to diabetes care-to investigate its association with the risk of hospitalization. Setting: Taiwan's National Health Insurance scheme from 1997 through 2002. Participants: Totally 6476 diabetic patients. Intervention(s). None: Main Outcome Measure(s). Diabetes-related short-term and long-term ambulatory care sensitive condition (ACSC) admissions. Results: Patients with ACSC admissions had significantly lower UPC scores compared with those without ACSC admissions. Using a Cox regression model that controlling for age, sex, severity of diabetes and the number of total visits, patients with low to medium continuity of care (UPC>,0.75) were found to be significantly associated with increased risk of hospitalization as compared with patients with high continuity of care, especially for long-term ACSC admissions (relative risk: 1.336 [1.019-1.751]). Conclusions Higher continuity of care with usual providers for diabetic care is significantly associated with lower risk of future hospitalization for long-term diabetic complication admissions. To avoid future hospitalization, health policy stakeholders are encouraged to improve the continuity of care through strengthening the provider-patient relationships. ? The Author 2009. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
Subjects
Ambulatory care; Continuity of care; Diabetes; Hospitalization
SDGs
Other Subjects
adult; ambulatory care; article; controlled study; diabetes mellitus; diabetic patient; disease severity; female; health care policy; health insurance; high risk patient; hospitalization; human; long term care; major clinical study; male; patient care; priority journal; risk assessment; Taiwan
Publisher
Oxford University Press
Type
journal article