Continuity of Care Improves Outcomes in Chronic Disease
Higher continuity linked to lower costs; ER use; complications in CHF, COPD, type 2 diabetes
WEDNESDAY, March 19, 2014 (HealthDay News) -- For Medicare beneficiaries with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and type 2 diabetes mellitus (T2DM), continuity of care is associated with differences in costs, emergency department use, and complications, according to a study published online March 17 in JAMA Internal Medicine.
Peter S. Hussey, Ph.D., from the RAND Corporation in Santa Monica, Calif., and colleagues reviewed insurance claims data for a 5 percent sample of Medicare beneficiaries experiencing a 12-month episode of care. Participants included 53,488 patients with CHF, 76,520 with COPD, and 166,654 with T2DM. Hospitalizations, emergency department visits, complications, and costs of care associated with the Bice-Boxerman continuity of care (COC) index were assessed.
The researchers found that higher levels of continuity for CHF, COPD, and T2DM correlated with lower odds of inpatient hospitalizations (odds ratios, 0.94, 0.95, and 0.95, respectively, for each 0.1-unit increase in COC); emergency department visits (odds ratios, 0.92, 0.93, and 0.94, respectively, for each 0.1-unit increase in COC); and complications (odds ratio range, 0.92 to 0.96 for three complication types), after multivariate adjustment. In adjusted analyses, each 0.1-unit increase in the COC index correlated with episode of care costs that were 4.7, 6.3, and 5.1 percent lower for CHF, COPD, and T2DM, respectively.
"Modest differences in care continuity for Medicare beneficiaries are associated with sizable differences in costs, use, and complications," the authors write.