Is Greater Continuity of Care Associated With Less Emergency Department Utilization?

Abstract

Greater COC with attending physicians in outpatient teaching clinics is associated with lower ED utilization.

Effect of Continuity of Care on Emergency Department Visits in Elderly Patients with Asthma in Taiwan

“…45 Studies have suggested an association of superior COC with fewer ED visits in different populations with asthma. 23,26,30,41,46 Our findings are consistent with those reported in a previous study focusing on children. 41 That study indicated that 42.3% of children with asthma had high COC (COCI ϭ 1), and those with medium or low COC had a higher risk of asthma-related ED visits (odds ratio, 1.21 and 1.38, respectively).…”

“…In addition, a previous study reported that children with asthma in Taiwan have a higher average COC score 41 than do those in America and Canada. 24,30 The continuous treatment of patients with asthma through inhaled medicine provides safe and effective long-term disease management. 45 Studies have suggested an association of superior COC with fewer ED visits in different populations with asthma.…”

“…Furthermore, patients with Ͻ4 outpatient visits during the COC period were excluded (n ϭ 4183). 25,26,30,31 In total, 3395 patients were included ( Figure 1). …”

“…A COCI of 1 indicates that all outpatient visits were to the same physician; in other words, patients had a continuous connection with 1 physician. This index has been widely adopted in studies using claim data sets 30,31,34,35 because the index is less sensitive to the number of physician visits and more suitable for a higher number of outpatient visits. 33 The general formula for COCI is as follows:…”

“…The CCI, which was calculated for each patient according to outpatient or inpatient care, was divided into 3 groups: 0, 1 to 2, and Ն3. 43 The number of ambulatory visits for asthma (4 -12, 13-24, and Ն25 times), 25,26,30 whether a patient was hospitalized for asthma, 24 and whether a patient had an ED visit for asthma 22,24,25 -all during the COC period-were used as proxies for disease severity.…”