title: Effects of continuity of care on hospital admission in patients with type 2 diabetes: analysis of nationwide insurance data.
abstract: 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.
authors: Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea. khcho404@yuhs.ac.|Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea. khcho404@yuhs.ac.
authors: Kyoung Hee
authors: KH
authors: Cho
authors: Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea. LEEVAN@yuhs.ac.|Graduate School of Public Health, Yonsei University, Seoul, South Korea. LEEVAN@yuhs.ac.
authors: Sang Gyu
authors: SG
authors: Lee
authors: Graduate School of Public Health, Yonsei University, Seoul, South Korea. BYJUN@yuhs.ac.
authors: Byungyool
authors: B
authors: Jun
authors: Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea. happiness630@hiramail.net.|Health Insurance Review & Assessment Institute, Health Insurance Review & Assessment Service, Seoul, South Korea. happiness630@hiramail.net.
authors: Bo-Young
authors: BY
authors: Jung
authors: Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea. kjh0930@yuhs.ac.|Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea. kjh0930@yuhs.ac.
authors: Jae-Hyun
authors: JH
authors: Kim
authors: Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea. ECPARK@yuhs.ac.|Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. ECPARK@yuhs.ac.
authors: Eun-Cheol
authors: EC
authors: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D056910:Republic of Korea; D055815:Young Adult