Abstract
BackgroundContinuity of care (CoC) is considered a central element of good primary care and is often measured using medical claims data. Possible values of CoC depend on the number of claims which is related to health status. This study investigated the relationships between CoC and health status and risk of emergency hospitalisation.MethodsHealth insurance claims for consultations with general practitioners (GPs) in the 24 months following entry to the 45 and Up Study were used to calculate usual provider continuity (UPC) and the Continuity of Care Index (CoC Index). Relationships of CoC with number of claims, self-rated health and emergency hospitalisation were investigated using descriptive statistics and logistic regression models.ResultsBoth measures of CoC were strongly related to number of claims and to measures of health status, which were in turn highly associated. Multivariable logistic regression models showed a weak positive relationship between CoC and odds of emergency hospitalisation for those with CoC less than 1, while individuals with perfect CoC had significantly lower odds of hospitalisation compared to all other categories of CoC. However, analyses stratified by, or adjusting for, number of claims showed no clear associations between CoC and risk of hospitalisation.ConclusionsThe pattern of association between CoC categories and emergency hospitalisation was non-linear and was confounded by the effect of number of claims. Future studies should apply caution in using claims-based measures of CoC as a continuous variable or employing an arbitrary cut-point, and should adjust for number of claims.
Highlights
Continuity of care (CoC) is considered a central element of good primary care and is often measured using medical claims data
Among a total of 266,950 participants in the 45 and Up Study, 44,007 (16%) were excluded (8,082 who died; 4,216 who held a Department of Veterans’ Affairs (DVA) healthcare card; 11 who had an average of >1 general practitioners (GPs) claim per day; and 31,698 who had less than 4 GP claims), leaving a total of 222,943 eligible participants for analysis
There was an average of 15 GP claims per participant
Summary
Continuity of care (CoC) is considered a central element of good primary care and is often measured using medical claims data. There are at least 17 different claims-based indices for measuring CoC [6], which can be generally grouped into three major categories: density of patient’s visits, dispersion of care providers, and sequence of visits to providers [8]. Many of these measures have similar methods of construction and are highly correlated [9, 10]
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