continuity of care and avoidable hospitalizations for chronic obstructive pulmonary disease (COPD).
BACKGROUND
Numerous studied suggest that better continuity of care could result in better health outcomes. However, few studies have examined the relationship between continuity of care and avoidable hospitalizations.


METHODS
A retrospective cohort study design was adopted. We used secondary data analysis based on claim data regarding health care utilization under a universal coverage health insurance scheme in Taiwan. The study population included 3,015 subjects who were newly diagnosed with chronic obstructive pulmonary disease (COPD) in 2006. The main outcome was COPD-related avoidable hospitalization, and the continuity of care index (COCI) was used to measure continuity of care. A logistic regression model was used to control for sex, age, low-income status, and health status.


RESULTS
With regard to the effects of continuity of care on avoidable hospitalizations, dose-response trends were observed. The logistic regression model showed that after controlling for covariables, subjects in the low COCI group were 129% (adjusted odds ratio, 2.29; 95% confidence interval, 1.26-4.15) more likely to undergo COPD-related avoidable hospitalizations than those in the high COCI group.


CONCLUSIONS
Patients with COPD with higher continuity of care had a significantly lower likelihood of avoidable hospitalization. To prevent future hospitalizations, health policy stakeholders should encourage physicians and patients to develop long-term relationships to further improve their health outcomes.
From the Institute of Health and Welfare Policy, National Yang-Ming University, Taiwan, Republic of China (I-PL, S-CW, S-TH); and the Department of Health Care Administration, Oriental Institute of Technology, Taiwan, Republic of China (LI-P).
I-Po
IP
Lin
From the Institute of Health and Welfare Policy, National Yang-Ming University, Taiwan, Republic of China (I-PL, S-CW, S-TH); and the Department of Health Care Administration, Oriental Institute of Technology, Taiwan, Republic of China (LI-P). scwu@ym.edu.tw.
Shiao-Chi
SC
Wu
From the Institute of Health and Welfare Policy, National Yang-Ming University, Taiwan, Republic of China (I-PL, S-CW, S-TH); and the Department of Health Care Administration, Oriental Institute of Technology, Taiwan, Republic of China (LI-P).
Shu-Tzu
ST
Huang
D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology
Chronic Obstructive Pulmonary Disease; Continuity of Care; Hospitalization