Effect of Continuity of Care on Emergency Care and Hospital Admissions Among Patients Receiving Home-Based Care: A Population-Based Cohort Study.

Abstract

We aimed to evaluate continuity of care (CoC) for patients receiving home-based care and assess its effect on urgent care use and hospital admissions. This cohort study used data from a population-based electronic health record system across 3 primary health care (PHC) centers in Barcelona, Spain, involving patients receiving permanent home care. We measured CoC with the usual provider of care for general practitioners (GPs) and nurses over a 1-year period. Associations were analyzed using adjusted logistic-mixed regression models. We used time-dependent receiver operating characteristic curves to identify the optimal CoC threshold and adjusted Cox survival models to examine cumulative incidence. We studied 1,207 patients (71.5% women) with a mean age of 88.5 years. General practitioners showed a mean CoC of 73.3% and PHC nurses 83.1%. Greater CoC for GPs and PHC nurses was associated with decreased urgent care use and hospital admissions (all odds ratios ≤ 0.45; <i>P</i> ≤ .004). An optimal CoC threshold of ≥75% for GPs was identified (sensitivity = 0.78; 95% CI, 0.74-0.83), with a modest area under the curve of 0.59 (95% CI, 0.55-0.62). Multivariate models showed that this threshold was significantly associated with decreased urgent care use and hospital admissions for both providers (hazard ratios = 0.61-0.69; <i>P</i> < .05). Greater CoC for GPs and nurses was associated with decreased urgent care and hospital admissions. A threshold of ≥75% of visits with assigned GPs or nurses might optimize health outcomes for these vulnerable patients. Maintaining a high level of relational CoC, particularly for older adults requiring home care services, can lead to more efficient and targeted health care utilization.