Association between continuity of care and emergency department visits and hospitalization in senior adults with asthma-COPD overlap

Abstract

a b s t r a c tObjective: To investigate associations between continuity of care (COC) and emergency department (ED) visits and hospitalization for chronic obstructive pulmonary disease (COPD) or asthma among elderly adults with asthma-COPD overlap (ACO). Methods: A retrospective cohort study was performed using the Taiwan National Health Insurance research database. A total of 1141 ACO patients aged ≥65 years during 2005-2011 were observed and followed for 2 years. The Bice and Boxerman COC index (COCI) was used to evaluate COC by considering ambulatory care visits duo to COPD or asthma in the first year; ED visits and hospitalization for COPD or asthma were identified in the subsequent year, respectively. The COCI was divided into three levels (COCI < 0.3= low, 0.3 ≤ COCI<1=medium, COCI = 1=high). The Cox model was used to estimate the hazard ratio (HR) for ED visits and hospital admissions due to COPD or asthma. Results: The average COCI was 0.55. 21.3% patients received outpatient care from a single physician. Compared to patients with high COC, those with low and medium COC had a higher risk of ED visits (aHR = 2.80 and 2.69, P < .01) and admissions (aHR = 1.80 and 1.72, P < .05). Conclusion: Increasing COC is beneficial for elderly patients with ACO in disease management. Policymakers could create effective pay-for-performance programs for the elderly ACO population to enhance COC and improve care outcomes.

Outcomes associated with higher relational continuity in the treatment of persons with asthma or chronic obstructive pulmonary disease: A systematic review

“…We identified 2824 unique references, of which 36 articles were read in full text. Sixteen articles fulfilled the inclusion criteria, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 of which one 25 was later excluded because of an unacceptable risk of bias. Of the 15 included articles, 14 were based on observational data, mainly retrospective cohort studies, and one 24 was a randomized controlled study.…”

“…Nine studies with a total of 525 716 participants investigated the effect of relational continuity of care on risk of future hospitalization. 12 , 13 , 14 , 15 , 16 , 18 , 19 , 21 , 22 The definition of hospitalization varied somewhat, but typically concerned hospitalization, re-hospitalization or condition-specific hospitalization. The analytic approaches also varied, where some studies compared lower to higher continuity while others did the opposite.…”

“…Five studies with a total of 362 305 participants investigated the effect of relational continuity of care on the risk of future ED-visits. 14 , 15 , 16 , 17 , 21 Two studies had overlapping populations. 16 , 17 All studies used various categorizations of the COC index in multiple logistic regressions or proportional hazard models.…”

Perception and Willingness to Maintain Continuity of Care by Parents of Children with Asthma in Taiwan

“…Maintaining continuity is particularly important for patients with asthma [ 8 , 24 , 25 ]. For children, asthma management may be different than for adults, because caregivers are the key link between health care providers and children with asthma [ 26 ], and they are often the key decision-makers with regards to medical care.…”

Emergency Department/Urgent Care as Usual Source of Care and Clinical Outcomes in CKD: Findings From the Chronic Renal Insufficiency Cohort Study

“…This is supported by data published in other chronic conditions including diabetes, chronic obstructive pulmonary disease, and cancer, which have demonstrated a positive association between continuity of care and improved outcomes, decreased cost, and fewer ED visits and hospitalizations. [13][14][15][16][17] In a study of Korean patients with diabetic nephropathy, superior quality continuity of care was associated with a decreased likelihood of progressing to end-stage kidney disease (ESKD) when compared to poorer quality continuity of care. 18 However, we are unaware of other studies that have evaluated the impact of usual source of care on adverse outcomes in a U.S. CKD cohort.…”