title: Continuity of diabetes care is associated with avoidable hospitalizations: evidence from Taiwan's National Health Insurance scheme.
abstract: OBJECTIVE
  Taiwan's health-care system allows patients to utilize specialty services without referrals by primary care providers. This discontinuity of care may lead to increases in future hospitalizations. This study aims to determine whether the discontinuity of care is associated with the risk of hospitalization.
  
  
  METHODS
  A secondary data analysis based on a claim data of a nationally representative random sample of diabetic patients in Taiwan. A usual provider continuity (UPC) index was developed-a ratio of the visits to the physician that subjects most usually see relevant to diabetes care to the total physician visits relevant to diabetes care-to investigate its association with the risk of hospitalization.
  
  
  METHODS
  Taiwan's National Health Insurance scheme from 1997 through 2002.
  
  
  METHODS
  Totally 6476 diabetic patients. INTERVENTION(s) None. MAIN OUTCOME MEASURE(s) Diabetes-related short-term and long-term ambulatory care sensitive condition (ACSC) admissions.
  
  
  RESULTS
  Patients with ACSC admissions had significantly lower UPC scores compared with those without ACSC admissions. Using a Cox regression model that controlling for age, sex, severity of diabetes and the number of total visits, patients with low to medium continuity of care (UPC <0.75) were found to be significantly associated with increased risk of hospitalization as compared with patients with high continuity of care, especially for long-term ACSC admissions (relative risk: 1.336 [1.019-1.751]).
  
  
  CONCLUSIONS
  Higher continuity of care with usual providers for diabetic care is significantly associated with lower risk of future hospitalization for long-term diabetic complication admissions. To avoid future hospitalization, health policy stakeholders are encouraged to improve the continuity of care through strengthening the provider-patient relationships.
authors.affiliation: Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Wender
authors.initials: W
authors.lastname: Lin
authors.forename: I-Chan
authors.initials: IC
authors.lastname: Huang
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Wang
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yang
authors.forename: Chih-Liang
authors.initials: CL
authors.lastname: Yaung
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D013624:Taiwan