Effects of long-term high continuity of care on avoidable hospitalizations of chronic obstructive pulmonary disease patients

Abstract

Objective: To examine the effects of high continuity of care (COC) maintained for a longer time on the risk of avoidable hospitalization of patients with chronic obstructive pulmonary disease (COPD).

Methods: A retrospective cohort study design was adopted. We used a claim data regarding health care utilization under a universal health insurance in Taiwan. We selected 2199 subjects who were newly diagnosed with COPD. We considered COPD-related avoidable hospitalizations as outcome variables. The continuity of care index (COCI) was used to evaluate COC as short- and long-term COC. A logistic regression model was used to control for sex, age, low-income status, disease severity, and health status.

Results: Long-term COC had stronger effect on health outcomes than short-term COC did. After controlling for covariables, the logistic regression results of short-term COC showed that the medium COCI group had a higher risk of avoidable hospitalizations (adjusted odds ratio [AOR]: 1.89, 95% CI: 1.07-3.33) than the high COCI group did. The results of long-term COC showed that both the medium (AOR: 1.98, 95% CI: 1.0-3.94) and low (AOR: 2.03, 95% CI: 1.05-3.94) COCI groups had higher risks of avoidable hospitalizations than did the high COCI group.

Conclusions: Maintaining long-term high COC effectively reduces the risk of avoidable hospitalizations. To encourage development of long-term patient-physician relationships could improve health outcomes.

Keywords: Avoidable hospitalization; Chronic obstructive pulmonary disease; Continuity of care.