The effects of continuity of care on hospital utilization in patients with knee osteoarthritis: analysis of Nationwide insurance data

Abstract

BackgroundKorea’s rapidly aging population has led to a rise in the prevalence of knee osteoarthritis (which reached upwards of 21.3% in 2017) in elderly people aged 65 years and over. Most patients with knee osteoarthritis require ongoing management in the community or through primary care. Continuity of care is a desirable attribute of primary care. However, previous studies on the association between continuity of care and health outcomes have focused on specific disease populations, particularly diabetes mellitus and hypertension. The objectives of this study were to determine whether there is an association between continuity of care for outpatients with knee osteoarthritis and health outcomes.MethodsWe conducted a cohort study using claims data from 2014. The study population included 131,566 patients. We measured hospital admission and medical costs during the final 3 months and the continuity of care by Most Frequent Provider Continuity (MFPC), Modified Modified Continuity Index (MMCI), and Continuity of Care (COC) index in the 9 preceding months, using multiple logistic regression analyses to determine which index best explains continuity. We evaluated the relationship between COC and hospital admissions, using negative binomial regression analysis due to over-dispersion. Finally, multiple regressions were used to examine the relationship between the COC and medical costs.ResultsWe selected the COC index to determine the association between hospital admission and cost; the area under the receiver operating characteristic curve (AUC) of the COC was the largest (0.904), while those for the MFPC (0.894) and MMCI (0.893) were similar. The negative binomial regression analysis showed that continuity of care was significantly related to hospitalization, with the relative risk (RR) of hospital admission being low for patients with high continuity of care [RR = 27.17 for those with the reference group COC (0.76–1.00); 95% CI, 3.09–3.51]. Continuity of care was significantly related to medical costs after considering other covariates. A higher COC index was associated with a lower cost.ConclusionsHigher continuity of care for knee osteoarthritis patients might decrease hospital admission and medical costs.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2951-y) contains supplementary material, which is available to authorized users.

Effect of a Nationwide Real‐Time Drug Utilization Review System on Duplicated Nonsteroidal Antiinflammatory Drug Prescriptions in Korea

“…Adding drug prescriptions to deal with adverse drug events may lead to prescribing cascades, and finally to polypharmacy and multiple drug‐related problems (24). The higher OR for NSAID TDs in females (Table 4) may be due to the greater number of ambulatory visits by women (25) or to women experiencing greater pain (26), either of which may lead to repeated prescriptions for NSAIDs or to switching between NSAIDs before taking all previously prescribed NSAIDs. Patients who mainly visited medical institutions, general hospitals, hospitals, and clinics were at lower risk of NSAID TDs than those who attended tertiary hospitals.…”

The effect of continuity of care on medical costs in patients with chronic shoulder pain

“…High- and low-COC groups were divided based on median values. To our best knowledge, there is no absolute standard for differentiating high and low COC, and as a result, previous studies applied various standards according to the research model, including the median 26 , tertiles 27 , quartiles 15 , and continuous 13 . Due to the relatively fewer events as compared to previous studies, we used the median as the standard for differentiating high and low COC in the main study.…”

“…Hussey PS et al 13 reported that patients with chronic diseases (congestive heart failure, chronic obstructive pulmonary disease, and diabetes) who have high COC showed decreased medical costs, hospitalisation rate, emergency department (ED) use, and complications. Health outcomes in previous studies included length of hospital stay 14 – 16 medical cost 11 , 13 , 15 , 17 , patient satisfaction 16 , and ED use 16 , 18 . However, studies on the relationship between COC and surgery are scarce.…”

“…Most COC studies are related to chronic internal medical diseases, such as metabolic syndrome, while very few studies have investigated the relationship between musculoskeletal pain disorders and COC. Jung et al 15 concluded that high COC might decrease hospital admission and medical costs for knee osteoarthritis patients. However, to our knowledge, there have been no reports of studies that investigated the effects of COC on health outcomes in patients with shoulder pain.…”

The association between general practitioner regularity of care and ‘high use’ hospitalisation

“…The Modified Regularity Index is a second iteration of an earlier index and is less correlated with frequency of GP contact [ 16 ]. Participants with < 3 GP visits were categorised separately because a regularity score could not be calculated for these individuals [ 30 , 31 ].…”