All-cause mortality in patients with chronic obstructive pulmonary disease is improved by a high level of continuity of care.
A high level of continuity of care (COC) improves all-cause mortality in patients with chronic obstructive pulmonary disease (COPD), according to a Korean study of 3090 COPD patients in a nationwide health insurance claims database. The study was published in PLOS One.
Kyong Hee Cho, MD, of the Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea, and colleagues conducted a longitudinal, population-based retrospective cohort study in adult patients with COPD from 2002 to 2012. The sample included patients ages 40 years and older who developed COPD in 2005 and survived until 2006. The main goal of the study was to measure COC over 7 years in patients with COPD and to investigate the association between COC and all causes of mortality. In addition, the study sought to identify other mortality-related factors in COPD patients.
The investigators defined continuity as longitudinal continuity. They calculated the COC index in subjects with 4 or more ambulatory care visits per year to reflect the distribution of visits to different healthcare institutions. It is influenced by both the total number of providers and the total number of visits. The index ranges from 0 to 1; a higher value corresponds to better COC.
A total of 60.8% of participants died prior to the end of the study. There was a statistically significant difference in adjusted median years of survival when home oxygen therapy was used (P = 0.04). In addition, unadjusted and adjusted median years of survival decreased as the number of hospital admissions increased. Median years of survival for individuals with high COC (COC index ≥0.75) was 3.92; median years of survival for patients with low COC (COC index <0.75) was 2.58.
Low COC was associated with a 22% increased risk of all-cause mortality. Not receiving oxygen therapy at home was associated with a 23% increased risk of all-cause mortality. The risk of all-cause mortality for patients admitted one time increased 38%, admitted two times was 63%, and admitted three or more times was 96% compared to the group with no admissions.
The researchers concluded that high COC was associated with a decreased risk of all-cause mortality and that home oxygen therapy and number of hospital admissions may predict mortality in patients with COPD. They noted that further research on the associations between COC and various healthcare outcomes, adjusting for potential confounders such as income, education, and health behaviors, is needed.