title: Effects of continuity of care on emergency department utilization in children with asthma.
abstract: OBJECTIVE
  To examine whether continuity of ambulatory asthma care can lower asthma-specific emergency department (ED) utilization by children with asthma in Taiwan.
  
  
  METHODS
  Retrospective cohort study based on claims data.
  
  
  METHODS
  We used the Taiwan National Health Insurance Dataset, 2006 to 2009. The study population was new asthma patients aged 0 to 17 years in 2007, and every case was observed for 2 years. We used the Continuity of Care Index (COCI) to calculate the continuity of ambulatory asthma care in the first year, and estimated the asthma-specific ED utilization in the second year. Two-part hurdle regression was used for statistical analysis.
  
  
  RESULTS
  The 29,277 patients in our study had an average COCI of 0.68 (± 0.31), and 42.3% of patients had an index of 1. More than 1 in 20 patients-1641 (5.61%)-had at least 1 asthma ED visit, and the mean number of visits per user was 1.46 (± 0.99). After controlling for covariates, the groups with medium and low continuity of ambulatory asthma care had 21% (odds ratio [OR], 1.21; 95% CI, 1.06-1.39) and 38% (OR, 1.38; 95% CI, 1.21-1.58) higher asthma-related ED utilization, respectively, than the group with high COCI. However, among users, the number of ED visits was not statistically correlated to the continuity of ambulatory asthma care.
  
  
  CONCLUSIONS
  High continuity of ambulatory asthma care can decrease asthma-specific ED utilization risk in children with newly diagnosed asthma in Taiwan. We suggest that providers and the government reinforce the use of follow-up care and education for high-risk groups to improve the continuity of ambulatory asthma care.
authors.forename: Shu-Tzu
authors.initials: ST
authors.lastname: Huang
authors.affiliation: Institute of Health and Welfare Policy, School of Medicine, National Yang Ming University, No. 155, Sec 2, Linong S, Taipei, 112 Taiwan, Republic of China. E-mail: scwu@ym.edu.tw.
authors.forename: Shiao-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Yen-Ni
authors.initials: YN
authors.lastname: Hung
authors.forename: I-Po
authors.initials: IP
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology