A time-duration measure of continuity of care to optimise utilisation of primary health care: a threshold effects approach among people with diabetes

Ninh Thi Ha, Mark Harris, David Preen, Suzanne Robinson, Rachael Moorin

Research output: Contribution to journalArticle

Abstract

BackgroundLiterature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses. However, the effect of timely access to primary care has not been fully captured in most of the current continuity of care indices. This study aimed to develop a time-duration measure of continuity of primary care (cover index) capturing the proportion of time an individual is under the potentially protective effect of primary health care contacts.MethodsAn observational study was conducted on 36,667 individuals aged 45years or older with diabetes mellitus extracted from Western Australian linked administrative data. Threshold effect models were used to determine the maximum time interval between general practitioner (GP) visits that afforded a protective effect against avoidable hospitalisation across complication cohorts. The optimal maximum time interval was used to compute a cover index for each individual. The cover was evaluated using descriptive statistics stratified by population socio-demographic characteristics.ResultsThe optimal maximum time between GP visits was 9-13months for people with diabetes with no complication, 5-11months for people with diabetes with 1-2 complications, and 4-9months for people with diabetes with 3+ complications. The cover index was lowest among those aged 75+ years, males, Indigenous people, socio-economically disadvantaged and those in very remote areas.ConclusionsThis study developed a new measure of continuity of primary care that adds a time parameter to capturing longitudinal continuity. Cover has the potential to better capture underuse of primary care and will significantly contribute to the sparsely available methods for analysis of linked administrative data in evaluating continuity of care for people with chronic conditions.

Original languageEnglish
Article number276
Number of pages14
JournalBMC Health Services Research
Volume19
Issue number1
DOIs
Publication statusPublished - 2 May 2019

Cite this

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title = "A time-duration measure of continuity of care to optimise utilisation of primary health care: a threshold effects approach among people with diabetes",
abstract = "BackgroundLiterature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses. However, the effect of timely access to primary care has not been fully captured in most of the current continuity of care indices. This study aimed to develop a time-duration measure of continuity of primary care (cover index) capturing the proportion of time an individual is under the potentially protective effect of primary health care contacts.MethodsAn observational study was conducted on 36,667 individuals aged 45years or older with diabetes mellitus extracted from Western Australian linked administrative data. Threshold effect models were used to determine the maximum time interval between general practitioner (GP) visits that afforded a protective effect against avoidable hospitalisation across complication cohorts. The optimal maximum time interval was used to compute a cover index for each individual. The cover was evaluated using descriptive statistics stratified by population socio-demographic characteristics.ResultsThe optimal maximum time between GP visits was 9-13months for people with diabetes with no complication, 5-11months for people with diabetes with 1-2 complications, and 4-9months for people with diabetes with 3+ complications. The cover index was lowest among those aged 75+ years, males, Indigenous people, socio-economically disadvantaged and those in very remote areas.ConclusionsThis study developed a new measure of continuity of primary care that adds a time parameter to capturing longitudinal continuity. Cover has the potential to better capture underuse of primary care and will significantly contribute to the sparsely available methods for analysis of linked administrative data in evaluating continuity of care for people with chronic conditions.",
keywords = "Cover index, Continuity of care, Optimal time interval, Diabetes mellitus, Primary care, Potentially preventable hospitalisation, SEVERITY INDEX, HOSPITALIZATION, MODELS, RISK, POPULATION, MORTALITY, LINKAGE",
author = "{Ninh Thi Ha} and Mark Harris and David Preen and Suzanne Robinson and Rachael Moorin",
year = "2019",
month = "5",
day = "2",
doi = "10.1186/s12913-019-4099-9",
language = "English",
volume = "19",
journal = "BMC Health Services Research",
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T1 - A time-duration measure of continuity of care to optimise utilisation of primary health care

T2 - a threshold effects approach among people with diabetes

AU - Ninh Thi Ha, null

AU - Harris, Mark

AU - Preen, David

AU - Robinson, Suzanne

AU - Moorin, Rachael

PY - 2019/5/2

Y1 - 2019/5/2

N2 - BackgroundLiterature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses. However, the effect of timely access to primary care has not been fully captured in most of the current continuity of care indices. This study aimed to develop a time-duration measure of continuity of primary care (cover index) capturing the proportion of time an individual is under the potentially protective effect of primary health care contacts.MethodsAn observational study was conducted on 36,667 individuals aged 45years or older with diabetes mellitus extracted from Western Australian linked administrative data. Threshold effect models were used to determine the maximum time interval between general practitioner (GP) visits that afforded a protective effect against avoidable hospitalisation across complication cohorts. The optimal maximum time interval was used to compute a cover index for each individual. The cover was evaluated using descriptive statistics stratified by population socio-demographic characteristics.ResultsThe optimal maximum time between GP visits was 9-13months for people with diabetes with no complication, 5-11months for people with diabetes with 1-2 complications, and 4-9months for people with diabetes with 3+ complications. The cover index was lowest among those aged 75+ years, males, Indigenous people, socio-economically disadvantaged and those in very remote areas.ConclusionsThis study developed a new measure of continuity of primary care that adds a time parameter to capturing longitudinal continuity. Cover has the potential to better capture underuse of primary care and will significantly contribute to the sparsely available methods for analysis of linked administrative data in evaluating continuity of care for people with chronic conditions.

AB - BackgroundLiterature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses. However, the effect of timely access to primary care has not been fully captured in most of the current continuity of care indices. This study aimed to develop a time-duration measure of continuity of primary care (cover index) capturing the proportion of time an individual is under the potentially protective effect of primary health care contacts.MethodsAn observational study was conducted on 36,667 individuals aged 45years or older with diabetes mellitus extracted from Western Australian linked administrative data. Threshold effect models were used to determine the maximum time interval between general practitioner (GP) visits that afforded a protective effect against avoidable hospitalisation across complication cohorts. The optimal maximum time interval was used to compute a cover index for each individual. The cover was evaluated using descriptive statistics stratified by population socio-demographic characteristics.ResultsThe optimal maximum time between GP visits was 9-13months for people with diabetes with no complication, 5-11months for people with diabetes with 1-2 complications, and 4-9months for people with diabetes with 3+ complications. The cover index was lowest among those aged 75+ years, males, Indigenous people, socio-economically disadvantaged and those in very remote areas.ConclusionsThis study developed a new measure of continuity of primary care that adds a time parameter to capturing longitudinal continuity. Cover has the potential to better capture underuse of primary care and will significantly contribute to the sparsely available methods for analysis of linked administrative data in evaluating continuity of care for people with chronic conditions.

KW - Cover index

KW - Continuity of care

KW - Optimal time interval

KW - Diabetes mellitus

KW - Primary care

KW - Potentially preventable hospitalisation

KW - SEVERITY INDEX

KW - HOSPITALIZATION

KW - MODELS

KW - RISK

KW - POPULATION

KW - MORTALITY

KW - LINKAGE

U2 - 10.1186/s12913-019-4099-9

DO - 10.1186/s12913-019-4099-9

M3 - Article

VL - 19

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

M1 - 276

ER -