Table 8: Results of Studies Assessing Continuity of Care in Patients With Diabetes.
| Study | N | Indices Used | Continuity Cut-Off | Proportion of Patients in Each Continuity Category | Hospitalization | ED Visits | Diabetes-Specific Outcomes |
| Chen &Cheng, 2011 (17) (Taiwan) | 48,107 | UPC, COC, SECON | < 0.47 low continuity 0.47–0.86 medium continuity ≥ 0.87 high continuity |
NR | Odds ratio (95% CI) UPC Low: 1.00 Medium: 0.61 (0.59–0.62) High: 0.26 (0.25–0.27) COC Low: 1.00 Medium: 0.58 (0.56–0.59) High: 0.26 (0.25–0.27) SECON Low: 1.00 Medium: 0.67 (0.66–0.69) High: 0.30 (0.29–0.31) |
Odds ratio (95% CI) UPC Low: 1.00 Medium: 0.68 (0.66–0.70) High: 0.35 (0.0.34–0.36) COC Low: 1.00 Medium: 0.64 (0.62–0.66) High: 0.34 (0.33–0.36) SECON Low: 1.00 Medium: 0.69 (0.67–0.72) High: 0.36 (0.35–0.37) |
NR |
| Worrall & Knight, 2011 (21) (Canada) | 305 | UPC | ≥ 0.75 high continuity < 0.75 low continuity |
Low: 27.2% High: 72.8% |
Percentage over 3 years: Low: 67.5% High: 54.5%b |
NR |
Mortality (percentage over 3 years): Low: 18.1% High: 9.0%b |
| Hong et al, 2010 (22) (Korea) | 268,220 | COC | Equal tertiles based on study population | NR | Odds ratio (95% CI) Low: 1.00 Medium: 0.75 (0.72–0.78)a High: 0.68 (0.66–0.71)a |
Odds ratio (95% CI) Low: 1.00 Medium: 0.77 (0.69–0.85)a High: 0.71 (0.64–0.79)a |
NR |
| Lin et al, 2010 (18) (Taiwan) | 6,476 | UPC | < 0.47 low continuity 0.47–0.75 medium continuity ≥ 0.75 high continuity |
NR | Odds ratio (95% CI) Long-term complications leading to admissions: Low: 1.00 Medium: 0.76 (0.58–1.00) High: 0.75 (0.58–0.98) a Short-term complications leading to admissions: Low: 1.12 (0.55–2.31) Medium: 0.78 (0.38–1.59) High: 0.89 (0.43–1.82) |
NR | NR |
| Liu et al, 2010 (23) (USA) | 3,873 | FCI (0–1) (low score, higher continuity) | Divided into quintiles | NR | NR | IRR: 0.87 (95% CI, 0.83–0.92; P < 0.01) | NR |
| Atlas et al, 2009 (19) (USA) | 155,590 (~10,000 with diabetes) | Created algorithm to define connectedness to physician, practice, or neither. | Equal tertiles based on study population | NR | NR | NR | HbA1c < 8% Physician connectedness: 74.7% (95% CI, 73.4–76.0) Practice connectedness: 70.5% (95% CI, 67.8–73.0) P = 0.004 |
| Knight et al, 2009 (16) (Canada) | 1,143 | UPC, COC, SECON | ≥ 0.75 high continuity < 0.75 low continuity |
COC Low: 36.6% High: 63.4% UPC Low: 23.7% High: 76.3% SECON Low: 18.5% High: 81.4% |
Odds Ratio (95% CI) High COC 0.82 (0.69–0.97) High UPC 0.82 (0.68–0.98) High SECON 0.75 (0.61–0.91) |
NR | NR |
| Mainous et al, 2004 (20) & Koopman et al, 2003(24) & Harvey et al, 2004(25) (USA) | 1400 | Based on responses to questions on NHANESa | 3 categories: no usual source of careusual site, but no usual providerusual site and provider | NR | NR | NR |
c Odds ratio, 95% CI HbA1c ≤ 7% No usual source: 1.00 Usual site: 11.81 (4.02–34.71) Usual provider: 6.69 (2.61–17.18) HbA1c ≤ 8% No usual source: 1.00 Usual site: 6.13 (2.08–18.04) Usual provider: 4.62 (2.02–10.60) SBP ≤ 130mmHg No usual source: 1.00 Usual site: 2.76 (0.70–10.93) Usual provider: 1.78 (0.55–5.72) SBP ≤ 140mmHg No usual source: 1.00 Usual site: 1.02 (0.28–3.78) Usual provider: 0.87 (0.36–2.13) Lipids ≤ 100mg/dL No usual source: 1.00 Usual site: 1.93 (0.71–5.24) Usual provider 1.10 (0.44–2.73) Lipids ≤ 130mg/dL No usual source: 1.00 Usual site: 2.37 (0.82–6.79) Usual provider: 1.59 (0.55–4.57) |
Abbreviations: CI, confidence interval; HbA1c, glycosylated haemoglobin; IRR, incidence rate ratio; N, number of patients; NHANES, National Health and Nutrition Examination Survey; NR, not reported.
a
Based on responses to the following questions on the NHANES:
• Is there a particular clinic, health center, doctor’s office, or other place that you usually go if you are sick, need advice about your health, or for routine care?
• If yes, is there one particular doctor or health professional you usually see?
b
P < 0.05
c
Results for all outcomes adjusted for age, gender, education, insurance coverage, health status, income, length of time with diabetes