Impact of continuity of care on preventable hospitalization of patients with type 2 diabetes: a nationwide Korean cohort study, 2002-10.
OBJECTIVE
To determine whether patients with greater continuity of care (COC) have fewer preventable hospitalizations.


METHODS
We conducted a cohort study using a stratified random sample of Korean National Health Insurance enrollees from 2002 to 2010. The COC index was calculated for each year post-diagnosis based on ambulatory care visits. We performed a recurrent event survival analysis via Cox proportional hazard regression analysis of preventable hospitalizations.


METHODS
A total of 5163 patients newly diagnosed with type 2 diabetes mellitus in 2003-6 and receiving oral hypoglycemic medication.


METHODS
Preventable hospitalization.


RESULTS
Of 5163 eligible participants, 6.4% (n = 328) experienced a preventable hospitalization during the study period. The adjusted hazard ratio (HR) was 8.69 (95% CI, 2.62-28.83) for subjects with a COC score of 0.00-0.19, 7.03 (95% CI, 4.50-10.96) for those with a score of 0.20-0.39, 3.01 (95% CI, 2.06-4.40) for those with a score of 0.40-059, 4.42 (95% CI, 3.04-6.42) for those with a score of 0.60-0.79 and 5.82 (95% CI, 3.87-8.75) for those with a score of 0.80-0.99. The difference in cumulative incidence of preventable hospitalizations in patients with COC scores of 0.00-0.19 relative to those with COC scores of 1.00 was the greatest, at 0.97% points.


CONCLUSIONS
Greater COC was associated with fewer preventable hospitalizations in subjects with type 2 diabetes.
Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea.
Kyoung Hee
KH
Cho
Department of Biostatistics, College of Medicine, Yonsei University, South Korea.
Chung Mo
CM
Nam
Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea.
Young
Y
Choi
Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea.
Jae-Woo
JW
Choi
Department of Nursing Science, College of Nursing, Gachon University, Incheon, South Korea.
Seon-Heui
SH
Lee
Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Eun-Cheol
EC
Park
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D056910:Republic of Korea; D016019:Survival Analysis; D055815:Young Adult
continuity of care; fragmented care; preventable hospitalization; recurrent event survival analysis