Does continuity of care matter in a health care system that lacks referral arrangements?

INTRODUCTION: Numerous studies have suggested that better continuity of care (COC) can lead to fewer emergency department (ED) visits and fewer hospital admissions. However, these studies were conducted in countries where patients have their own family physician or in countries with referral systems. This study aimed to determine whether the association between lower COC and increased health care utilization may be apparent in a health care system that lacks a family physician or a referral system. METHODS: The study population included a total of 134 422 subjects who made four or more visits to physicians in 2005. Negative binominal regressions were performed to examine the effects of three different COC indices on the numbers of hospital admissions and ED visits in 2005 and in the subsequent year (2006). RESULTS: The data suggest that lower COC was associated with increased hospital admissions and ED visits in our study population. Compared with the high COC group, subjects in the low and medium COC groups had 42-82% and 39-46% more hospital admissions, respectively, as well as 75-102% and 41-45% more ED visits, respectively, in 2005. Weaker protective effects of COC were also observed in the subsequent year. CONCLUSIONS: This study indicates that lower COC is associated with increased hospital admissions and ED visits, even in a health care system that lacks a referral arrangement framework. This suggests that improving the COC is beneficial both for patients and for the health care system.

A longitudinal examination of continuity of care and avoidable hospitalization: evidence from a universal coverage health care system.

BACKGROUND: Few studies have examined the effect of continuity of care on avoidable hospitalization, and the results have been inconclusive. This study aimed to examine the effects of continuity of care on avoidable hospitalization and hospital admission for any condition in a health care system with a high level of access to care. METHODS: We used a longitudinal design to examine claims data that captured health care utilization between January 1, 2000, and December 31, 2006, under a universal coverage health insurance program in Taiwan. In total, 30 830 randomly selected subjects with 3 or more physician visits per year between 2000 and 2006 were analyzed in 3 age groups. The main outcome was avoidable hospitalization and hospital admission for any condition. A random intercept logistic regression model was used to control for age, sex, low-income status, health status, time effect, and random subject effect. RESULTS: Higher continuity of care was significantly associated with lower likelihood of avoidable hospitalization in all 3 age groups. Similar associations were found for hospital admission for any condition in the 3 age groups. CONCLUSIONS: Better continuity of care is associated with fewer avoidable hospitalizations and fewer hospital admissions for any condition in a health care system with easy access to care. Therefore, improvement of continuity of care is an appropriate path to follow in a universal coverage health care system.