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Effects of continuity of care on hospital admission in patients with type 2 diabetes: analysis of nationwide insurance data

 Kyoung Hee Cho  ;  Sang Gyu Lee  ;  Eun-Cheol  ;  Jae-Hyun Kim  ;  Bo-Young Jung  ;  Byungyool Jun 
 BMC Health Services Research, Vol.15 : 107, 2015 
Journal Title
 BMC Health Services Research 
Issue Date
Adult ; Aged ; Aged, 80 and over ; Chronic Disease/therapy* ; Continuity of Patient Care/organization & administration* ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/therapy* ; Female ; Hospitalization/statistics & numerical data* ; Humans ; Male ; Middle Aged ; National Health Programs/statistics & numerical data* ; Odds Ratio ; Patient Admission/statistics & numerical data* ; Primary Health Care/organization & administration* ; Republic of Korea ; Young Adult
COC ; Continuity of care ; ICOC ; SECON ; Type 2 diabetes ; UPC
BACKGROUND: A system for managing chronic disease including diabetes mellitus based on primary care clinics has been used in Korea since April 2012. This system can reduce copayments for patients that are managed by a single primary-care provider and lead to improve continuity of care. The aim of this study is to determine whether there is an association between continuity of care for outpatients and hospital admission and identify the continuity index that best explains hospital admissions for patients with type 2 diabetes. METHODS: We performed a cross-sectional study using 2009 National Health Insurance Sample (NHIS) from the Health Insurance Review & Assessment Services (HIRA) of Korea. The dependent variable was hospital admission due to type 2 diabetes mellitus. Continuity of care was measured using the Usual Provider Care index (UPC), Continuity of Care index (COC), Sequential Continuity of Care index (SECON), and Integrated Continuity of Care index (ICOC). RESULTS: Patients with low COC scores (<0.75) were more likely to be hospitalized [odds ratio, 2.44; 95% CI, 2.17-2.75] compared with the reference group (COC ≥0.75), after adjusting for all covariates. we calculated the area under the receiver operating characteristic (AUROC) curve for each index to find which index had the greatest explanatory ability for hospital admission. The AUROC of the COC was the greatest (0.598), but the AUROC curves for the UPC (0.597), SECON (0.593), and ICOC (0.597) were similar. CONCLUSIONS: High continuity of care may reduce the likelihood for hospital admission. The COC had marginally more explanatory power.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Kim, Jae-Hyun(김재현)
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
Lee, Sang Gyu(이상규) ORCID logo https://orcid.org/0000-0003-4847-2421
Jun, Byung Yool(전병율)
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