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.
Highlights
Korea’s rapidly aging population has led to a rise in the prevalence of knee osteoarthritis in elderly people aged 65 years and over
The objectives of this study were to determine whether there is an association between continuity of care for outpatients with knee osteoarthritis and two health outcomes
We evaluated the relationship between Continuity of Care (COC) and hospital admissions in each COC group using a negative binomial regression analysis, which was chosen due to over-dispersion
Summary
Korea’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. 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. The population of Korea is rapidly aging due to the declining birthrate and increased life expectancy. The percentage of those aged 65 years or more is estimated to increase from 10.3% in 2008 to 15.6% in 2020 and 38.2% in 2050 [12]. The prevalence rate in those aged 65 years or more has been continuously increasing, reaching 21.3% in 2017 [14]
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