title: Continuity of care trajectories and emergency room use among patients with diabetes.
abstract: OBJECTIVE
  To analyze the pattern of continuity of care (COC) using trajectory analysis for a group of patients newly diagnosed with diabetes, and determine whether various trajectories lead to distinct patient outcomes.
  
  
  METHODS
  We used the Taiwan National Health Insurance claims database. Newly diagnosed patients with diabetes in 2005 totaling 4367 were included in this study. All patients were followed up to 2011. We identified groups of COC trajectories using trajectory analysis. We subsequently determined whether various COC trajectories were associated with the frequency of total and diabetes-related emergency room (ER) use using negative binomial models.
  
  
  RESULTS
  We discovered five distinct COC trajectories for our newly diagnosed diabetes sample based on trajectory analysis. The early-seeker group had the lowest IRR for total ER visits (IRR = 0.56, P < 0.001), followed by the high-maintainer group (IRR = 0.67, P < 0.001). Similar results were obtained for diabetes-specific ER use.
  
  
  CONCLUSIONS
  We identified various COC trajectories for diabetes patients. Chronic disease patients may seek a suitable physician by compromising care continuity at the onset of disease progression and exhibit favorable outcome.
authors.affiliation: Institute of Hospital and Healthcare Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hui-Ying
authors.initials: HY
authors.lastname: Tsai
authors.forename: Yiing-Jenq
authors.initials: YJ
authors.lastname: Chou
authors.forename: Christy
authors.initials: C
authors.lastname: Pu
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013624:Taiwan