The Effect of Continuity of Care on Emergency Room Use for Diabetic Patients Varies by Disease Severity.

Chia-Hsiang Hsu,Christy Pu,Yiing-Jenq Chou

doi:10.2188/jea.je20150045

Chia-Hsiang Hsu, Christy Pu + Show 1 more

Open Access

https://doi.org/10.2188/jea.je20150045

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Abstract

BackgroundAlthough many studies have reported that high-quality continuity of care (COC) is associated with improved patient outcomes for patients with diabetes, few studies have investigated whether this positive effect of COC depends on the level of diabetes severity.MethodsA total of 3781 newly diagnosed diabetic patients selected from the 2005 National Health Insurance database were evaluated for the period 2005–2011. Generalized estimating equations combined with negative binomial estimation were used to determine the influence of COC on the overall emergency room (ER) use and diabetes mellitus (DM)-specific ER use. Analyses were stratified according to diabetes severity (measured using the Diabetes Complications Severity Index [DCSI]), comorbidities (measured using the Charlson comorbidity score), and age.ResultsCOC effects varied according to diabetes severity. Stratified analysis showed that the positive effect of COC on DM-specific ER use was the highest for a DCSI of 0 (least severe), with an incidence rate ratio (IRR) of 0.49 (95% CI, 0.41–0.59) in the high-COC group (reference group: low-COC group). Compared with the low-COC group, high-quality COC had a significant beneficial effect on overall ER use in younger patients (IRR 0.51; 95% CI, 0.39–0.66 for the youngest [18–40 years] group, and IRR 0.67; 95% CI, 0.59–0.76 for the oldest [>65 years] group) and those with a high number of comorbidities.ConclusionsThe positive effects of high-quality COC on the treatment outcomes of patient with diabetes, based on the overall and DM-specific ER use, depends on the level of disease severity. Therefore, providing health education to enhance high-quality COC when the disease severity is low may be critical for ensuring optimal positive effects during diabetes disease progression.

Highlights

Continuity of care (COC) is a crucial aspect of family medicine[1] and entails having a regular provider for disease treatment, thereby enhancing patient outcomes through care responsibility instead of managing specific conditions individually.[2]
This study investigated whether continuity of care (COC) interacts with diabetes severity to affect the total number of overall emergency room (ER) and DMspecific ER visits
Many previous studies have reported that high-quality COC is associated with lower frequency of ER visits; to our knowledge, none of these studies has investigated whether this effect depends on disease severity

Summary

Introduction

Continuity of care (COC) is a crucial aspect of family medicine[1] and entails having a regular provider for disease treatment, thereby enhancing patient outcomes through care responsibility instead of managing specific conditions individually.[2] Numerous studies have reported that highquality COC is associated with improved outcomes in patients with diabetes. These positive patient outcomes include decreased all-cause mortality,[3] decreased acute and avoidable hospitalization rates,[3,4,5] improved weight control, reduced fasting blood glucose,[6] and greater patient satisfaction.[7] In addition, several studies have reported an association between high-quality COC and decreased emergency room (ER) use for patients with diabetes.[8,9,10]. Providing health education to enhance high-quality COC when the disease severity is low may be critical for ensuring optimal positive effects during diabetes disease progression

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Results

Conclusion