Continuity of care may lower costs for chronically ill older adults

Better continuity of care among older adults with chronic diseases may ultimately be less costly and lead to fewer hospitalizations, emergency department visits and complications, based on the findings of a study published online March 17 in JAMA Internal Medicine.

Researchers led by Peter S. Hussey, PhD, of the RAND Corporation in Boston, retrospectively studied Medicare claims data of a sample of 241,722 patients who received 12 months of care for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and/or type 2 diabetes mellitus (DM) in 2008 and 2009. To measure continuity of care (COC), the investigators used the Bice-Boxerman COC index.

As outcomes, they determined whether each patient had at least one inpatient hospitalization and/or emergency department. They also measured the incidence of complications related to the primary condition, comorbidities or patient safety.

The average COC index was 0.55 for CHF, 0.60 for COPD and 0.5 for DM. After adjusting for multiple variables, including age, sex and census region, the investigators found higher levels of continuity associated with lower odds of being hospitalized (odds ratios [OR] for a 0.1-unit increase in COC were 0.94 for CHF, 0.95 for COPD and 0.95 for DM. A higher COC was also associated with lower odds of emergency department visits (OR 0.92 for CHF, 0.93 for COPD and 0.94 for CM) and lower odds of complications (OR range 0.92 to 0.96 for the three conditions and for complications related to the primary condition, comorbidity and patient safety).

Better continuity of care was also associated with lower costs. For every 0.1-unit increase in COC index, the costs for an episode were 4.7 percent lower for CHF, 6.3 percent lower for COPD and 5.1 percent lower for DM.

Although the authors acknowledge a number of limitations, including the use of a COC index that may be unfamiliar and the potential lack of generalizability of the data, they argued that their findings point to the importance of continuity of care.

“With changes in healthcare delivery and payment, it will be necessary to measure whether these reforms have an effect on continuity and, in turn, reduce healthcare use, the rates of complications, and costs of care,” they wrote.