An Integration of Care Continuity and Volume-Outcome: Glaucoma Detection

• Main Authors: Yu-Chin Lu, 呂昱瑾
• Other Authors: Christy Pu
• Format: Others
• Language: en_US
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/s4m6km

碩士 === 國立陽明大學 === 醫務管理研究所 === 107 === Introduction Glaucoma is the second leading cause of irreversible blindness around the world, and patients with poor follow-up are significantly more likely to progress into severe glaucomatous conditions. Continuity of care is related to quality of care over a period of time. It is the procedure by which patients and their healthcare team are collaboratively involved in health care management toward the shared purpose of high-quality care. Given that there was an abundant literature on the relationship between good care continuity and positive patient outcome, no study had investigated whether such effect vary by provider service volume. In health economic literature, high volume is often associated with better patient outcome, and thus hypothetically speaking, high continuity should have a positive interaction effect with provider volume. Objectives This study aimed to explore that continuity of care could improve quality of care and lead to high detection (or diagnosis) in glaucoma. Particularly, we aimed to verify an interaction effect between health providers’ service volume and continuity of care on glaucoma detection. Methods Data from Taiwan National Health Insurance Research Database during 2007 to 2016 were used. We conducted a nested case-control study of patients who had glaucoma diagnosis and medication use. Patients who progressed into a poor outcome within one year from their first confirmed diagnosis were defined as the late detection group. Then we calculated continuity of care index and frequency of outpatient visits of subjects and compared difference between two groups. Provider volume was defined as within a particular year: 1. Total number of ophthalmology patients ,2. Total number of glaucoma patients, and 3. The proportion of glaucoma patients among ophthalmology patients. The interaction effect between continuity of care and physician volume was examined by multivariate logistic regression. Results Lower volume providers, measured using either indicator, were more likely to detect late glaucoma cases. In addition, there was no significant interaction effect between high care continuity and low-volume providers. Though the results are not statistically significant, patients who visited lower volume physicians but had higher continuity of care index with that provider had higher possibility of developing into worse patient outcome (OR = 4.31, P = 0.056). Conclusion Continuity of care improved quality of care and patient outcome. Moreover, there is no interaction effect between care continuity and physician volume. Promoting high care continuity with low volume providers may call for more concern. Due to high healthcare accessibility, patients often hospital or doctor shop and may visit “good doctor” depending on physician service volume. While previous studies often propose high continuity of care, it cannot improve late detection significantly. We believed strategies to reduce late detection should focus on traditional factors.