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Am J Manag Care. 2011 Jun;17(6):420-7.

Better continuity of care reduces costs for diabetic patients.

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Institute of Health Policy and Management, National Taiwan University, 17 Xu-Zhou Road, Taipei, Taiwan.



To examine the effects of continuity of care on healthcare utilization and expenses for patients with diabetes mellitus.


Longitudinal study based on claims data.


Data on healthcare utilization and expenses from a 7-year period (2000-2006) were gathered from claims data of the Taiwanese universal health insurance system. The continuity of care index (COCI) was analyzed, and the values were classified into 3 levels. Outcome variables included the likelihood of hospitalization and emergency department visit, pharmaceutical expenses for diabetes-related conditions, and total healthcare expenses for diabetes-related conditions. A generalized estimating equation that considered the effects of repeated measures for the same patients was applied to examine the effects of continuity of care on healthcare utilization and expenses.


Compared with patients who had low COCI scores, patients with high or medium COCI scores were less likely to be hospitalized for diabetes related conditions (odds ratio [OR] 0.26, 95% confidence interval [CI] 0.25, 0.27, and OR 0.58, 95% CI 0.56, 0.59, respectively) or to have diabetes-related emergency department visits (OR 0.34, 95% CI 0.33, 0.36, and OR 0.64, 95% CI 0.62, 0.66, respectively). Patients with low COCI scores incurred $126 more in pharmaceutical expenses than patients with high COCI scores. Furthermore, patients with high COCI scores had greater savings ($737) in total healthcare expenses for diabetes-related conditions than patients with low COCI scores.


Better continuity of care was associated with less healthcare utilization and lower healthcare expenses for diabetic patients. Improving continuity of care might benefit diabetic patients.

[Indexed for MEDLINE]
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