Key result
Lower continuity of care linked to ~3.6-fold higher odds of hospital admission in asthmatic children.
Why the study?
Does lower continuity of care increase hospital admissions in asthmatic children?
Cohort (n=9,997)
Does lower continuity of care increase hospital admissions in asthmatic children?
Effect estimate: OR 3.61 (95% CI 2.98-4.38)
Market competition appears to reduce continuity of care, which is associated with a higher risk of hospital admissions for asthmatic children.
Supports continuity-focused strategies in pediatric asthma; hypothesis-generating for causality and interventions.
BACKGROUND: Ambulatory care-sensitive conditions, including asthma, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization. OBJECTIVE: This study assessed the relationship between market competition, continuity of care (COC), and hospital admissions in asthmatic children according to their health care provider. METHODS: A longitudinal design was employed with a 5-year follow-up period, between 2009 and 2013, under a Korean universal health insurance program. A total of 253 geographical regions were included in the analysis, according to data from the Korean Statistical Office. Data from 9,997 patients, aged ≤ 12 years, were included. We measured the COC over a 5-year period using the Usual Provider Continuity (UPC) index. Random intercept models were calculated to assess the temporal and multilevel relationship between market competition, COC, and hospital admission rate. RESULTS: Of the 9,997 patients, 243 (2.4%) were admitted to the hospital in 2009. In the multilevel regression analysis, as the Herfindahl-Hirschman Index increased by 1,000 points (denoting decreased competitiveness), UPC scores also increased (ß = 0.001; p < 0.0001). In multilevel logistic regression analysis, the adjusted odds ratio (OR) for hospital admissions for individuals with lower COC scores (≥ 2 ambulatory visits and a UPC index score of < 1) was 3.61 (95% CI: 2.98-4.38) relative to the reference group (≥ 2 ambulatory visits and a UPC index score of 1). CONCLUSIONS: Market competition appears to reduce COC; decreased COC was associated with a higher OR for hospital admissions.
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Cho et al. (2016) conducted a cohort in Asthma (n=9,997). Lower continuity of care (≤2 ambulatory visits and UPC index < 1) vs. Higher continuity of care (≥2 ambulatory visits and UPC index = 1) was evaluated on Hospital admissions due to asthma (OR 3.61, 95% CI 2.98-4.38). Lower continuity of care was associated with a 3.61-fold higher odds of hospital admissions among asthmatic children.
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