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Continuity of Outpatient Care and Avoidable Hospitalization: A Systematic Review

Yu-Hsiang Kao, PhD; Wei-Ting Lin, PhD; Wan-Hsuan Chen, MPH; Shiao-Chi Wu, PhD; and Tung-Sung Tseng, DrPH

ABSTRACT

Objectives: Continuity of care (COC) is a core element of primary care, which has been associated with improved health outcomes. Hospitalizations for ambulatory care–sensitive conditions (ACSCs) are potentially preventable if these conditions are managed well in the primary care setting. The aim of this article is to conduct a systematic review of literature on the association between COC and hospitalizations for ACSCs.

Study Design: Systematic literature review.

Methods: All published literature was searched for in PubMed and MEDLINE using PRISMA guidelines for collecting empirical studies. Studies published in English between 2008 and 2017 that measured the association between COC and at least 1 measure of ACSC hospitalizations were included in this review.

Results: A total of 15 studies met the inclusion criteria and applied claims data to examine the association between COC and ACSC hospitalizations. Most studies (93.3%) demonstrated a statistically significant association of higher COC in the outpatient setting with reduced likelihood of hospitalization for either all ACSCs or a specific ACSC. A strong association was observed among studies focusing on patients with a specific ACSC. Additionally, most studies used the Bice-Boxerman COC index to measure COC and measured COC before a period of measuring ACSC hospitalizations.

Conclusions: This systematic review identified that increased COC in outpatient care is associated with fewer hospitalizations for ACSCs. Increasing COC is favorable for patients who are managing a specific ACSC.

Am J Manag Care. 2019;25(4):e126-e134

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