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OBJECTIVES: This study examined the relationship between claims-based and patient-reported continuity of care (COC) measures and investigated the effects of the 2 types of COC measures on subjective and objective health care outcomes. STUDY DESIGN: A prospective, cross-sectional, correlational survey design was used. A nationwide face-toface interview survey of community-dwelling older adults was conducted, and the survey participants' health claims records were retrieved and linked under the universal health insurance system of Taiwan in 2018. METHODS: Health care outcomes were measured subjectively (patient satisfaction and perceived lack of coordination) and objectively (likelihood of hospital admissions and emergency department [ED] visits). COC was measured using claims-based and multidimensional patient-reported COC. Ordered logit and logit models were used to examine the relationship between the 2 types of COC measures, and health care outcomes were measured subjectively and objectively. Average marginal effects with bootstrapped SEs were computed for health care outcomes. RESULTS: This study demonstrated that the correlations of claims-based and patient-reported COC measures were quite low and mainly insignificant. A higher claims-based COC was significantly associated with a lower likelihood of hospital admissions, ED visits, and perceived lack of coordination. No significant relationship was identified between claims-based COC and patient satisfaction. Participants reporting higher COC had better patient satisfaction and less perceived lack of coordination. However, no relationship was identified between patient-reported COC and the likelihood of hospital admissions and ED visits. CONCLUSIONS: The correlation between claims-based and patient-reported COC measures is low, and claims-based and patient-reported COC measures are associated with different subjective and objective health care outcomes. We suggest that claims-based COC indicators representing the pattern of physician visits might be considered a unique dimension of COC. [ABSTRACT FROM AUTHOR]

Continuity of care (COC) is an essential issue in primary healthcare. Under the national health insurance (NHI) program in Taiwan, easy access to care and lack of referral may hamper the improvement of COC. This study reviews the evolution of the concept and measurement of COC, empirical studies concerning the relationship between COC and healthcare outcomes, and methodological issues. We retrieved studies from MEDLINE and Chinese Electronic Periodical Services databases from 1950 to 2012 and completed a manual review of cited articles to identify studies related to COC. A total of 61 studies were included in this review. In summary, there is emerging consensus on the concept of COC. "Interpersonal" and "information" are two essential dimensions of the concept of COC. Due to the increasing availability of administrative data, quantitative measures of COC have been commonly employed in recent studies. Compared to earlier studies with no consistent findings, the majority of recent studies have reported that better COC was associated with favorable healthcare outcomes and reduced healthcare expenses. We suggest that researchers consider the study design, handle temporal relationships between COC and healthcare outcome, and choose appropriate measures for determining COC according to their research objectives. In addition, future studies might focus on the mechanism between COC and healthcare outcomes, and the relative importance of various COC dimensions on healthcare outcomes. This review may be of interest to researchers in Taiwan. [ABSTRACT FROM AUTHOR]

The article discusses a study on the effect of continuity of care on avoidable hospitalization under a health care system with easy access to care using a longitudinal analysis. Database made up of one million subjects chosen in 25 subsets of randomly selected samples from the whole National Health Insurance (NHI) enrollee profile was the main data source. It suggests that increasing community of care in a health care system with a high degree of access to care could reduce avoidable hospitalization.

Introduction: Both care continuity and coordination are considered essential elements of health care system. However, little is known about the relationship between care continuity and coordination. This study aimed to differentiate the concepts of care continuity and coordination by developing and testing the reliability and validity of the Combined Outpatient Care Continuity and Coordination Assessment (COCCCA) questionnaire under the universal coverage health care system in Taiwan from a patient perspective. Methods: Face-to-face interviews were conducted nationwide with communitydwelling older adults selected via stratified multistage systematic sampling with probability-proportional-to-size process. A total of 2,144 subjects completed the questionnaire, with a response rate of 44.67%. Results: The 16 items of the COCCCA questionnaire were identified via item analysis and principal component analysis (PCA). The PCA generated five dimensions: three continuity-oriented (interpersonal, information sharing and longitudinal between patients and physicians) and two coordination-oriented (information exchange and communication/cooperation among multiple physicians). The second-order confirmatory factor analysis supported the factor structure and indicated that distinct constructs of care continuity and coordination can be identified. Conclusion: The COCCCA instrument can differentiate the concepts of care continuity and care coordination and has been demonstrated to be valid and reliable in outpatient care settings from a patient perspective. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate medication use among the elderly in an outpatient setting has been widely reported. However, the potential association between inappropriate medication use and adverse outcomes is seldom examined. Objectives: To identify the prevalence, risk factors for and adverse outcomes of potentially inappropriate medication use in ambulatory elderly patients with chronic diseases. Methods: Data for this observational cohort study consisted of computerized claims from a tertiary medical centre in Taiwan to the Bureau of National Health Insurance. Consecutive ambulatory elderly patients aged ≥65 years who received long-term (3-month) prescriptions for treatment of a chronic disease were recruited from 1 to 31 March 2005. The cohort included 5741 elderly patients who received 7538 long-term prescriptions. Patients who required repeat prescriptions were able to be given the same prescription if their conditions were stable. The prevalence of potentially inappropriate medication use and the incidence of adverse outcomes, including emergency visits, hospitalizations and mortality, were documented for up to 6 months after the first day the patient was recruited. Beers' 2002 criteria were used to determine the potential inappropriateness of prescribed medications. Associations between potentially inappropriate medications and adverse outcomes were examined by multivariate logistic regression analyses controlling for possible confounding factors. Results: The prevalence of potentially inappropriate medication use was 23.7% in the studied hospital. The most frequently prescribed potentially inappropriate medications of high severity (i.e. having a high likelihood of being associated with an adverse effect that was clinically significant) were amiodarone, chlorzoxazone, bisacodyl, nifedipine and amitriptyline. Logistic regression analysis revealed that female sex, advanced age, number of chronic diseases and number of medications taken all significantly increased the likelihood of receiving potentially inappropriate medications. The incidence of adverse outcomes in patients with potentially inappropriate medication use in the studied hospital was 25.1%. Multivariate logistic regression analysis revealed that potentially inappropriate medication use was significantly associated with hospitalization. Conclusions: Potentially inappropriate medication use is not a rare event in elderly patients and is associated with higher risk of hospitalization in this age group. In order to reduce the possibility of prescribing inappropriate medications, and therefore to reduce the consequent risk of hospitalization, more attention should be paid when prescribing drugs to, in particular, older female patients with multiple chronic illnesses that require treatment with multiple medications. [ABSTRACT FROM AUTHOR]