Modified Continuity Index Research Articles

Continuity of care and mortality in patients with type 2 diabetes.

How continuity of general practitioner care (GP-CoC) affects mortality in patients with type 2 diabetes (T2D) is unclear. The aim of this study was to examine the effect of having no continuity of care (CoC) and GP-CoC on mortality in primary health care (PHC) patients with T2D. Cohort study in patients aged 60 years or older with T2D within the public PHC of the city of Vantaa, Finland. Inclusion period was between 2002-2011 and follow-up period between 2011-2018. Six groups were formed (no appointments, one appointment and Modified, Modified Continuity Index [MMCI] quartiles). Mortality was measured with standardized mortality ratio (SMR) and adjusted hazard ratio (aHR). GP-CoC was measured with MMCI. Comorbidity status was determined with Charlson comorbidity index (CCI). In total 11,020 patients were included. Mean follow-up time was 7.3 years. SMRs for the six groups (no appointments, one appointment, MMCI quartiles) were 2.46 (95%CI: 2.24-2.71), 3.55 (3.05-4.14), 1.15 (1.06-1.25), 0.97 (0.89-1.06), 0.92 (0.84-1.01) and 1.21 (1.11-1.31), respectively. With continuous MMCI, mortality formed a u-curve. The inflection point was at a MMCI value of 0.65 with corresponding SMR of 0.86. Age and CCI adjusted HR for death between men and women was 1.45 (1.35-1.58). Patients with no CoC had the highest mortality. In patients having care over time, the effect of GP-CoC on mortality was minor and mortality turned to rise with high GP-CoC.

Association between continuity of care and inappropriate prescribing in outpatient care in Germany: a cross-sectional analysis conducted as part of the LoChro trial

ObjectivesPotentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are common in multimorbid patients. This study aims to describe PIMs and PPOs in an open-access outpatient setting and to investigate...

Effects of the COVID-19 Pandemic on the Medical Use of Elderly Patients with Hypertension: A Nationwide Cohort Study in Korea.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services, including chronic disease management, for vulnerable groups, such as older individuals with hypertension. This study aimed to evaluate hypertension management in South Korea's elderly population during the pandemic using treatment consistency indices such as the continuity of care (COC), modified, modified continuity index (MMCI), and most frequent provider continuity (MFPC). This study used the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service between 2017 and 2021. The research included a total of 4,097,299 hypertensive patients aged 65 years or older. We defined 2018 and 2019 as the baseline period before the COVID-19 pandemic and 2020 and 2021 as the COVID-19 period and calculated the indices of medical continuity (number of visits, COC, MMCI, and MFPC) on a yearly basis. The number of visits decreased during the COVID-19 period compared to the baseline period (59.64±52.75 vs. 50.49±50.33, P<0.001). However, COC, MMCI, and MFPC were not decreased in the baseline period compared to the COVID-19 period (0.71±0.21 vs. 0.71±0.22, P<0.001; 0.97±0.05 vs. 0.96±0.05, P<0.001; 0.8±0.17 vs. 0.8±0.17, P<0.001, respectively). COVID-19 had no significant impact on the continuity of care but affected the frequency of outpatient visits for older patients with hypertension. However, this study highlights the importance of addressing healthcare inequalities, especially in older patients with hypertension, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.

Association of Continuity of Care With Health Care Utilization and Expenditures Among Patients Discharged Home After Stroke or Transient Ischemic Attack.

To examine the association of prestroke continuity of care (COC) with postdischarge health care utilization and expenditures. The study population included 2233 patients with a diagnosis of stroke or a transient ischemic attack hospitalized in one of 41 hospitals in North Carolina between March 2016 and July 2019 and discharged directly home from acute care. COC was assessed from linked Centers for Medicare and Medicaid Services Medicare claims using the Modified, Modified Continuity Index. Logistic regressions and 2-part models were used to examine the association of prestroke primary care COC with postdischarge health care utilization and expenditures. Relative to patients in the first (lowest) COC quartile, patients in the second and third COC quartiles were more likely [21% (95% CI: 8.5%, 33.5%) and 33% (95% CI: 20.5%, 46.1%), respectively] to have an ambulatory care visit within 14 days. Patients in the highest COC quartile were more likely to visit a primary care provider but less likely to see a stroke specialist. Highest as compared with lowest primary care COC quartile was associated with $45 lower (95% CI: $14, $76) average expenditure for ambulatory care visits within 30 days postdischarge. Patients in the highest, as compared with the lowest, primary care COC quartile were 36% less likely (95% CI: 8%, 64%) to be readmitted within 30 days postdischarge and spent $340 less (95% CI: $2, $678) on unplanned readmissions. These findings underscore the importance of primary care COC received before stroke hospitalization to postdischarge care and expenditures.

EFFECTS OF THE COVID-19 ON MEDICAL USE OF ELDERLY PATIENTS WITH HYPERTENSION: A NATIONWIDE COHORT STUDY IN KOREA.

Abstract COVID-19 pandemic disrupted healthcare services, including chronic disease management for vulnerable groups like older individuals with hypertension. This study aims to evaluate hypertension management in South Korea’s elderly population during the pandemic using treatment consistency indices like Continuity of Care (COC), Modified, Modified Continuity Index (MMCI), Most Frequent Provider Continuity (MFPC). This study used the the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service (NHIS) between 2017 and 2021 The research included a total of 4,097,299 hypertensive patients aged 65 or older. We defined 2018 and 2019 as baseline period before COVID 19 pandemic, and 2020 and 2021 as COVID 19 period, and calculated the indices of medical continuity (Number of visits, COC, MMCI and MFPC) on a yearly basis were measured. The number of visits were decreased during COVID 19 period compared to baseline period ( 59.64 ±52.75 to 50.49 ± 50.33, p&amp;lt; 0.001) respectively. However COC, MMCI and MFPC were not decreased in baseline period compared to COVID-19 period ( 0.71 ± 0.21 vs. 0.71 ± 0.22, p&amp;lt; 0.001), (0.97 ± 0.05 vs. 0.96 ± 0.05, p&amp;lt; 0.001), and (0.8 ± 0.17 vs. 0.8 ± 0.17, p&amp;lt; 0.001) respectively. In conclusion, COVID-19 had no significant impact on continuity of care, but it did affect the frequency of outpatient visits of older hypertensive patients. However, this study highlights the importance of addressing healthcare inequalities, especially for older hypertensive patients, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.

Continuity of primary care and emergency department visits following knee and hip replacement surgery: a retrospective cohort study.

Continuity of primary care (CPC) improves patient well-being, but the association between CPC and surgical outcomes has not been well studied. The numbers of joint replacement procedures are expected to rise considerably in the coming years, so it is crucial to identify factors related to successful outcomes. The purpose of this study was to examine the association between CPC and emergency department (ED) visits after knee and hip replacement surgery. Physician claims and hospital data from 2005 to 2020 in Nova Scotia were used in this retrospective study. To measure CPC, we used the Modified Modified Continuity Index (MMCI), which is the number of primary care providers adjusted for the total number of visits. The outcome was ED visits within 90 days of discharge. Logistic regression was used to test for associations between MMCI and the probability of an ED visit. There were 28 574 knee and 16 767 hip procedures in the data set; 13.9% (95% confidence interval [CI] 13.5%-14.3%) and 13.5% (95% CI 13.0%-14.0%) of the patients, respectively, had an ED visit within 90 days. For patients who underwent knee procedures, the mean MMCI was 0.868 (95% CI 0.867-0.870); 10.7% (95% CI 10.4 %-11.1 %) had perfect continuity of care. For patients who underwent hip procedures, the corresponding measures were 0.864 (95% CI 0.862-0.866) and 13.5% (95% CI 13.0%-14.0%). There was a statistically significant negative association between greater continuity of care and the probability of an ED visit after controlling for confounders. Having multiple primary care providers before surgery increased the likelihood of negative outcomes following knee or hip replacement surgery compared with having a single provider. Presurgical conversations should include primary care history to improve postsurgical outcomes.

Continuity of care and treatment intensity at the end of life in Swiss cancer patients.

Continuity of care (COC) was shown to be associated with fewer hospitalizations. We aimed to evaluate whether COC was associated with intensive intervention(s) at the end of life (IEOL), a preference-sensitive outcome, in cancer patients. The study is based on claims data of patients with incident use of anti-neoplastics in Switzerland. COC Index, Usual Provider Continuity score, Sequential Continuity index and Modified Modified Continuity Index were calculated based on consultations with the usual ambulatory care physician. Treatment intensity was evaluated in the last 6 months of life, and COC was evaluated in months 18-6 before death in those who died between 24 and 54 months after incident cancer. IEOL comprised life-sustaining interventions (cardiac catheterization, cardiac assistance device implantation, pulmonary artery wedge monitoring, cardiopulmonary resuscitation/cardiac conversion, gastrostomy, blood transfusion, dialysis, mechanical ventilator utilization and intravenous antibiotics) and measures specifically used in cancer patients (last dose of chemotherapy ≤14 days of death, a new chemotherapy regimen starting <30 days before death, ≥1 emergency visit in the last month of life, ≥1 hospital admission or spending >14 days in hospital in the last month of life and death in an acute-care hospital). All COC scores were inversely associated with the occurrence of an IEOL, as were older age, homecare nursing utilization and density of ambulatory care physicians. For COC Index, odds ratio was 0.55 (95% confidence interval 0.37-0.83). COC scores were consistently and inversely related to IEOL. The study supports efforts to improve COC for cancer patients at their end of life.

Telehealth Use, Care Continuity, and Quality: Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic.

Community health centers (CHCs) pivoted to using telehealth to deliver chronic care during the coronavirus COVID-19 pandemic. While care continuity can improve care quality and patients' experiences, it is unclear whether telehealth supported this relationship. We examine the association of care continuity with diabetes and hypertension care quality in CHCs before and during COVID-19 and the mediating effect of telehealth. This was a cohort study. Electronic health record data from 166 CHCs with n=20,792 patients with diabetes and/or hypertension with ≥2 encounters/year during 2019 and 2020. Multivariable logistic regression models estimated the association of care continuity (Modified Modified Continuity Index; MMCI) with telehealth use and care processes. Generalized linear regression models estimated the association of MMCI and intermediate outcomes. Formal mediation analyses assessed whether telehealth mediated the association of MMCI with A1c testing during 2020. MMCI [2019: odds ratio (OR)=1.98, marginal effect=0.69, z=165.50, P<0.001; 2020: OR=1.50, marginal effect=0.63, z=147.73, P<0.001] and telehealth use (2019: OR=1.50, marginal effect=0.85, z=122.87, P<0.001; 2020: OR=10.00, marginal effect=0.90, z=155.57, P<0.001) were associated with higher odds of A1c testing. MMCI was associated with lower systolic (β=-2.90, P<0.001) and diastolic blood pressure (β=-1.44, P<0.001) in 2020, and lower A1c values (2019: β=-0.57, P=0.007; 2020: β=-0.45, P=0.008) in both years. In 2020, telehealth use mediated 38.7% of the relationship between MMCI and A1c testing. Higher care continuity is associated with telehealth use and A1c testing, and lower A1c and blood pressure. Telehealth use mediates the association of care continuity and A1c testing. Care continuity may facilitate telehealth use and resilient performance on process measures.

Care Continuity, Telehealth Use, and Quality of Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study

Background Community health centers (CHCs) pivoted to remote chronic care services during the COVID-19 pandemic. While care continuity is associated with improved care quality and patients’ experiences, telehealth’s impact on these relationships is unclear. Objective We aimed to examine the association among care continuity, telehealth use, and quality of diabetes or hypertension care in CHCs before and during the COVID-19 pandemic. Methods We collected electronic health record data from a cohort of 20,792 patients with diabetes or hypertension with ≥2 visits per year from March to December 2019 and 2020 among 166 California CHCs in the OCHIN Accelerating Data Value Across a National Community Health Center Network Collaborative. Logistic regression models estimated the association between care continuity (modified, modified continuity index [MMCI]) and telehealth adoption and blood pressure or hemoglobin A1c (HbA1c) testing. Generalized linear regression models for 2019 and 2020 estimated the association between MMCI and blood pressure or HbA1c, exploring telehealth as a mediator. Results Patients experienced reduced care continuity (2019: MMCI=0.71, SD 0.28; 2020: MMCI=0.63, SD 0.36; P&lt;.001) and more blood pressure (99.99% vs 99.75%) and HbA1c (53.38% vs 48.99%) assessments in 2019 vs 2020. Telehealth accounted for 0.33% of 2019’s visits and 9.55% of 2020’s visits. MMCI scores were associated with higher odds of telehealth use in 2020 (odds ratio [OR] 1.96; P&lt;.001). MMCI (2019: OR 1.72, P&lt;.001; 2020: OR 1.66, P&lt;.001) and telehealth use (2019: OR 2.44, P&lt;.001; 2020: OR 6.82, P&lt;.001) were associated with greater HbA1c testing. MMCI was associated with lower HbA1c values in 2020 (–0.40, P=.01) and lower systolic (2019: –1.64, P=.045; 2020: –2.40, P=.001) and diastolic (2019: –1.24, P=.007; 2020: –1.33, P=.001) blood pressure. MMCI and telehealth were not associated with HbA1c values in 2019. In 2020, telehealth mediated the relationship between MMCI and HbA1c testing (percent mediated 59%), but not between MMCI and other study outcomes. Conclusions Care continuity facilitates telehealth use and enables resilient performance on process measures. Elucidating how care continuity influences telehealth adoption may provide insights about implementing patient-centered innovations.

Analysis of Continuity of Care and Its Related Factors in Diabetic Patients: A Cross-Sectional Study.

BackgroundContinuity of care in primary care settings is crucial for managing diabetes. We aimed to statistically define and analyze continuity factors associated with demographics, clinical workforce, and geographical relationships.MethodsWe used 2014–2015 National Health Insurance Service claims data from the Korean registry, with 39,096 eligible outpatient attendance. We applied multivariable logistic regression to analyze factors that may affect the continuity of care indices for each patient: the most frequent provider continuity index (MFPCI), modified-modified continuity index (MMCI), and continuity of care index (COCI).ResultsThe mean continuity of care indices were 0.90, 0.96, and 0.85 for MFPCI, MMCI and COCI, respectively. Among patient factors, old age >80 years (MFPCI: odds ratio [OR], 0.81; 95% confidence interval [CI], 0.74–0.89; MMCI: OR, 0.84; 95% CI, 0.76–0.92; and COCI: OR, 0.81; 95% CI, 0.74–0.89) and mild disability were strongly associated with lower continuity of care. Another significant factor was the residential area: the farther the patients lived from their primary care clinic, the lower the continuity of diabetes care (MFPCI: OR, 0.74; 95% CI, 0.70–0.78; MMCI: OR, 0.70; 95% CI, 0.66–0.73; and COCI: OR, 0.74; 95% CI, 0.70–0.78).ConclusionThe geographical proximity of patients’ residential areas and clinic locations showed the strongest correlation as a continuity factor. Further efforts are needed to improve continuity of care to address the geographical imbalance in diabetic care.

Outpatient care fragmentation in Veterans Affairs patients at high-risk for hospitalization.

To examine outpatient care fragmentation and its association with future hospitalization among patients at high risk for hospitalization. Veterans Affairs (VA) and Medicare data. We conducted a longitudinal study, using logistic regression to examine how outpatient care fragmentation in FY14 (as measured by number of unique providers, Breslau's Usual Provider of Care (UPC), Bice-Boxerman's Continuity of Care Index (COCI), and Modified Modified Continuity Index (MMCI)) was associated with all-cause hospitalizations and hospitalizations related to ambulatory care sensitive conditions (ACSC) in FY15. We also examined how fragmentation varied by patient's age, gender, race, ethnicity, marital status, rural status, history of homelessness, number of chronic conditions, Medicare utilization, and mental health care utilization. We extracted data for 130,704 VA patients ≥65 years old with a hospitalization risk ≥90th percentile and ≥ four outpatient visits in the baseline year. The mean (SD) of FY14 outpatient visits was 13.2 (8.6). Fragmented care (more providers, less care with a usual provider, more dispersed care based on COCI) was more common among patients with more chronic conditions and those receiving mental health care. In adjusted models, most fragmentation measures were not associated with all-cause hospitalization, and patients with low levels of fragmentation (more concentrated care based on UPC, COCI, and MMCI) had a higher likelihood of an ACSC-related hospitalization (AOR, 95% CI=1.21 (1.09-1.35), 1.27 (1.14-1.42), and 1.28 (1.18-1.40), respectively). Contrary to expectations, outpatient care fragmentation was not associated with elevated all-cause hospitalization rates among VA patients in the top 10th percentile for risk of admission; in fact, fragmented care was linked to lower rates of hospitalization for ACSCs. In integrated settings such as the VA, multiple providers, and dispersed care might offer access to timely or specialized care that offsets risks of fragmentation, particularly for conditions that are sensitive to ambulatory care.

Continuity of care and mortality in people with schizophrenia.

People with schizophrenia have shortened lives. This excess mortality seems to be related to physical health conditions that may be amenable to better primary and secondary prevention. Better continuity of care may enhance such interventions as well as help prevent death by self-injury. We set out to examine the relationship between the continuity of care of patients with schizophrenia, their mortality and cause of death. Pseudoanonymised community data from 5551 people with schizophrenia presenting over 11 years were examined for changes in continuity of care using the numbers of community teams caring for them and the Modified Modified Continuity Index. These and demographic variables were related to death certifications of physical illness from the Office of National Statistics and mortal self-injury from clinical data. Data were analysed using generalised estimating equations. We found no independent relationship between levels of continuity of care and overall mortality. However, lower levels of relationship continuity were significantly and independently related to death by self-injury. We found no evidence that continuity of care is important in the prevention of physical causes of death in schizophrenia. However, there is evidence that declining relationship continuity of care has an independent effect on deaths as a result of self-injury. We suggest that there should be more attention focused on the improvement of continuity of care for these patients.

Influence of organization and demographic characteristics of primary care practices on continuity of care: analysis of a retrospective cohort from 287 primary care practices covering about 6 million people in Catalonia

BackgroundThere is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. The main objective of this study is to describe the continuity of care in primary healthcare in Catalonia (Spain) and to analyze whether the organization of primary care practices (PCP) or their patients’ sociodemographic characteristics play a role in its continuity of care.MethodsFour indices were used to measure continuity of care: Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity Index (SECON). The study was conducted on 287 PCP of the Catalan Institute of Health (Institut Català de la Salut—ICS). Each continuity of care index was calculated at the patient level (3.2 million patients and 35.5 million visits) and then aggregated at the PCP level. We adjusted linear regression models for each continuity index studied, considering the result of the index as an independent variable and demographic and organizational characteristics of the PCP as explanatory variables. Pearson correlation tests were used to compare the four continuity of care indices.ResultsIndices’ results were: UPC: 70,5%; MMCI: 73%; COC: 53,7%; SECON: 60,5%. The continuity of care indices had the highest bivariate correlation with the percentage of appointments booked with an assigned health provider (VISUBA variable: the lower the value, the higher the visits without an assigned health provider, and thus an organization favoring immediate consultation). Its R2 ranged between 56 and 63%, depending on the index. The multivariate model which explained better the variability of continuity of care indices (from 49 to 56%) included the variables VISUBA and rurality with a direct relationship; while the variables primary care physician leave days and training practices showed an inverse relationship.ConclusionStudy results suggest that an organization of primary care favoring immediate consultation is related to a lower continuity of patient care.

Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme

There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.

Continuity of Care in Swiss Cancer Patients Using Claims Data.

BackgroundContinuity of care is positively associated with beneficial patient outcomes. Data on the level of continuity of care in the ambulatory setting in Switzerland are lacking.AimThe aim of this study was to evaluate continuity of care in Swiss cancer patients based on routine data of mandatory health insurance using four established continuity scales.MethodsRetrospective analysis of Swiss claims data (N=23ʹ515 patients with incident use of antineoplastics). The Usual Provider Continuity score, the Modified Modified Continuity Index, the Continuity of Care index, and the Sequential Continuity Index were analyzed based on consultations with general practitioners (GPs), physician specialists and ambulatory hospital wards.ResultsUsing information of health insurance claims, the number of consultations and the general level of continuity of care in Swiss cancer patients are high. Continuity of care scores were significantly associated with sociodemographic and regional factors. When focusing on consultations with GPs only, all four scores consistently showed high values indicating high levels of continuity. Continuity with general practitioners was associated with lower costs and lower risks for hospitalization and death.ConclusionThis is the first study giving insight into continuity of care in Swiss cancer patients. The present study shows that continuity of care is measurable using health insurance claims data. It indicates that continuity with general practitioners is associated with a beneficial outcome.

Longitudinal continuity of care during antenatal and delivery in the Volta Region of Ghana.

To determine the extent of longitudinal continuity of care (CoC) during pregnancy and delivery in the Volta Region of Ghana. Longitudinal data were used from the National Health Insurance Claims Dataset for the period January to December 2013 for pregnant women who sought antenatal and delivery care in the region. Pregnant women who delivered at a health facility with at least three visits were included in the study. Five CoC indices were calculated for each pregnant woman. Of the 14474 pregnant women included in the study, 58.4% had perfect CoC. Mean CoC indices were: most frequent provider continuity (MFPC) 0.82±0.25; modified, modified continuity index (MMCI) 0.86±0.20; continuity of care index (COCI) 0.76±0.30; sequential continuity index (SECON) 0.80±0.28; and place of delivery continuity (PDC) 0.68±0.41. There are relatively medium to high levels of CoC indices during pregnancy and delivery, with place of delivery CoC having the lowest score, an indication that more pregnant women switched providers during delivery. There is a need for policy to ensure CoC during pregnancy.

Association between continuity of care and type 2 diabetes development among patients with thyroid disorder.

Thyroid disorders are associated with blood glucose abnormalities. For rendering the patients euthyroid, routine screening and care are essential. Therefore, the aim of this study was to investigate the association between continuity of care (COC) and type 2 diabetes onset among patients with thyroid disorders.We used the national claim data. Our study population was 4099 patients with hyperthyroidism or hypothyroidism. For calculating COC, the Most Frequent Provider Continuity Index (MFPCI), Modified Modified Continuity Index (MMCI), and COC Index (COCI) were used. The dependent variable was type 2 diabetes onset. The Cox proportional hazard regression model was used.Among 4099 patients with thyroid disorders, 25.3% experienced onset of type 2 diabetes. Thyroid patients who had MFPCI and COCI below the median were more likely to experience onset of type 2 diabetes than who had these indices above the median (MFPCI: hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.09–1.46; COCI: HR = 1.22, 95% CI = 1.06–1.41). Our subgroup analysis showed that female patients and those 20 to 34 years of age showed a significant association between COC and onset of type 2 diabetes.Patients with thyroid disorders with low COC showed an increased risk of developing type 2 diabetes. Therefore, efforts to enhance COC among patients with thyroid disorders needs to be encouraged.

Association between continuity of care and long-term mortality in Taiwanese first-ever stroke survivors: An 8-year cohort study.

BackgroundContinuity of care is considered to be an important principle of stroke care; however, few analyses of empirically related outcomes have been reported.ObjectiveThis study examined the correlation between the continuity of care for outpatients after a stroke event and the survival of stroke patients over the year following hospital discharge.Research designData from the Taiwan National Health Insurance Database were used in this study. We defined stroke as the ICD-9-CM codes 430 to 437, and all patients were followed up regarding their survival for at least one year. The modified modified continuity index (MMCI) was used as the indicator of continuity of care. Cox proportional hazard models with robust sandwich variance estimates were employed to analyze the correlation between continuity of care and stroke-related death.ResultsA total of 9,252 stroke patients were included in the analysis. Those patients who had a high and a completed COC had a higher percentage of survival (97.25% and 95.39%) compared to the other two groups. After controlling for other variables, compared with the low-level continuity of care group, the moderate-level, high-level and completed continuity of care groups still showed a significantly lower risk of death HR (95% CI) were: 0.63 (0.49–0.80), 0.56 (0.40–0.79) and 0.50 (0.39–0.63), respectively.ConclusionContinuity of care may increase the survival among stroke patients and therefore plays an important role in management of stroke after survival.

Continuity of care and clinical outcomes in the community for people with severe mental illness.

High continuity of care is prized by users of mental health services and lauded in health policy. It is especially important in long-term conditions like schizophrenia. However, it is not routinely measured, and therefore not often evaluated when service reorganisations take place. In addition, the impact of continuity of care on clinical outcomes is unclear.AimsWe set out to examine continuity of care in people with schizophrenia, and to relate this to demographic variables and clinical outcomes. Pseudoanonymised community data from 5552 individuals with schizophrenia presenting over 11 years were examined for changes in continuity of care using the numbers of community teams caring for them and the Modified Modified Continuity Index (MMCI). These and demographic variables were related to clinical outcomes measured with the Health of the Nation Outcome Scales (HoNOS). Data were analysed using generalised estimating equations and multivariate marginal models. There was a significant decline in MMCI and significant worsening of HoNOS total scores over 11 years. Higher (worse) HoNOS scores were significantly and independently related to older age, later years and both lower MMCI and more teams caring for the individual in each year. Most HoNOS scales contributed to the higher total scores. There is evidence of declining continuity of care in this 11-year study of people with schizophrenia, and of an independent effect of this on worse clinical outcomes. We suggest that this is related to reorganisation of services.Declaration of interestNone.

The effects of continuity of care on hospital utilization in patients with knee osteoarthritis: analysis of Nationwide insurance data

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.