BackgroundThe increasing prevalence of multiple chronic conditions has accentuated the importance of coordinating and integrating health care services. Patients with better continuity of care (COC) have a lower utilization rate of emergency department (ED) services, lower hospitalization and better care outcomes. Previous COC studies have focused on the care outcome of patients with a single chronic condition or that of physician-patient relationships; few studies have investigated the care outcome of patients with multiple chronic conditions. Using multi-chronic patients as subjects, this study proposes an integrated continuity of care (ICOC) index to verify the association between COC and care outcomes for two scopes of chronic conditions, at physician and medical facility levels.MethodsThis study used a dataset of 280,840 subjects, obtained from the Longitudinal Health Insurance Database (LHID 2005), compiled by the National Health Research Institutes, of the National Health Insurance Bureau of Taiwan. Principal Component Analysis (PCA) was used to integrate the indices of density, dispersion and sequence into ICOC to measure COC outcomes - the utilization rate of ED services and hospitalization. A Generalized Estimating Equations model was used to verify the care outcomes.ResultsWe discovered that the higher the COC at medical facility level, the lower the utilization rate of ED services and hospitalization for patients; by contrast, the higher the COC at physician level, the higher the utilization rate of ED services (odds ratio > 1; Exp(β) = 2.116) and hospitalization (odds ratio > 1; Exp(β) = 1.688). When only those patients with major chronic conditions with the highest number of medical visits were considered, it was found that the higher the COC at both medical facility and physician levels, the lower the utilization rate of ED services and hospitalization.ConclusionsThe study shows that ICOC is more stable than single indices and it can be widely used to measure the care outcomes of different chronic conditions to accumulate empirical evidence. Concentrated care of multi-chronic patients by a single physician often results in unsatisfactory care outcomes. This highlights the need for referral mechanisms and integration of specialties inside or outside medical facilities, in order to optimize patient-centered care.
We conclude that the patients receiving comprehensive periodontal treatment have better clinical outcomes than the patients receiving conventional periodontal treatment.
Objective: To use linked NSW Cancer Registry and hospital lung cancer (LC) data for raising discussion points on how to improve outcomes. Design: Historical cohort – cases diagnosed in 2003-2007. Setting: New South Wales, Australia Outcome Measures: Relative odds (OR) of localised disease and resection of non-small cases (NSCLC) using multiple logistic regression. Comparisons of risk of NSCLC death using competing risk regression. Findings: (1) Older patients have fewer resections of localised NSCLC [adjusted OR 95% CLs; 80+Vs <60 years; 0.20 (0.14, 0.28)]. Cases with co-morbidity have fewer resections [adjusted OR, 0.74 (0.61, 0.90)] and have more conservative resections. Question: Is there the best balance between resection and avoiding surgery to accommodate frailty and co-morbidity? (2) Compared with public patients, the health insured: have higher odds of localised LC [adjusted OR, 1.23 (1.12, 1.35] and resection for localised NSCLC [adjusted OR, 2.08 (1.70, 2.54)]; are more likely to have lobectomies than wedge/segmental resections (p<0.001); and have a lower risk of LC death [adjusted SHR, 0.89 (0.85, 0.93)]. Question: Are there opportunities for improving publicpatient outcomes? (3) Patients born in non-English speaking countries have lower odds of localised disease [adjusted OR, 0.88 (0.79, 0.99)]. – Question: Could this difference be decreased by reducing cultural and language barriers? (4) Cancers of pulmonary lobes rather than the main bronchus pose lower risks of LC death. Question: Could outcomes for main bronchus cancers be improved by up-skilling or referral to higher-volume centres? (5) Greater extent of disease is strongly predictive of case fatality – Question: Could LC deaths be reduced by earlier treatment? (6) Use of lobectomies varies – Question: Could survival be increased through greater use of lobectomies for localised NSCLC? Conclusions: Linked cancer registry and hospital data can increase system-wide understanding of local health-service delivery and prompt discussion points on how to improve outcomes. Abbreviations: APDC – Australian Patient Data Collection; CHeReL – Centre for Health Record Linkage; EOD – Extent of Disease; LC – Lung Cancer; NSCLC – Non-Small Cell Cancers; NSWCR – New South Wales Cancer Registry; OR – Relative Odds; SEIFA – Socio-Economic Index for Areas; SES – Socio- Economic Status.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.