A longitudinal examination of continuity of care and avoidable hospitalization: evidence from a universal coverage health care system.

Cheng, Shou-Hsia; Chen, Chi-Chen; Hou, Yen-Fei

BACKGROUND Few studies have examined the effect of continuity of care on avoidable hospitalization, and the results have been inconclusive. This study aimed to examine the effects of continuity of care on avoidable hospitalization and hospital admission for any condition in a health care system with a high level of access to care. METHODS We used a longitudinal design to examine claims data that captured health care utilization between January 1, 2000, and December 31, 2006, under a universal coverage health insurance program in Taiwan. In total, 30 830 randomly selected subjects with 3 or more physician visits per year between 2000 and 2006 were analyzed in 3 age groups. The main outcome was avoidable hospitalization and hospital admission for any condition. A random intercept logistic regression model was used to control for age, sex, low-income status, health status, time effect, and random subject effect. RESULTS Higher continuity of care was significantly associated with lower likelihood of avoidable hospitalization in all 3 age groups. Similar associations were found for hospital admission for any condition in the 3 age groups. CONCLUSIONS Better continuity of care is associated with fewer avoidable hospitalizations and fewer hospital admissions for any condition in a health care system with easy access to care. Therefore, improvement of continuity of care is an appropriate path to follow in a universal coverage health care system.