What Impact Does Prior Continuity of Care Have on Hospital Readmissions?
The chronic disease model suggests continuity of care and team based care are necessary to improve outcomes for multi-morbidity patients and reduce hospitalizations. Continuity of care following admission has had mixed effects on readmission rates. The effect continuity of care prior to admission has upon readmission rates is not well studied.
A cohort of 14,662 primary care patients who were admitted during 2011-13 were studied. Continuity of care in the twelve months prior to admission was assessed using three established metrics; usual provider continuity (UPC), dispersion continuity of care (COC), and sequence continuity (SECON). Additionally, because these established metrics may not accurately reflect continuity in planned team-based care, a novel metric called visit entropy (VE) was used to quantify the disorganization of visits. Multivariate logistic regression examined the relationship between the dependent variable, readmission within thirty days, and continuity while controlling for typical risk factors such as demographics, prior emergency department visits, prior hospitalizations, and co-morbidities.
VE was associated with readmission (Odds Ratio 1.10, 95%CI 1.02-1.19). The continuity measures of UPC, COC, and SECON were not associated with readmission. Typical risk factors such as age, marital status, number of emergency department visits, previous hospitalizations, Charlson comorbidity, and length of stay were also associated with readmission.
Lower continuity of care, characterized by a more disorganized visit pattern and thus higher VE, was associated with increased odds of readmission. An association between traditional measures of continuity (UPC, COC, and SECON) and readmission was not found, perhaps because these traditional measures suffer from skewed distributions, undefined division by zero, and the inability to distinguish planned team based care from random visits. VE may represent a better measure of continuity of care within the team based chronic disease model.