Department of Health Economics and Health Management, Institute of Health and Society, University of Oslo, PO Box 1089 Blindern, NO-0317 Oslo, Norway.
Berlin Centre of Health Economics Research (BerlinHECOR), Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, Berlin, 10623, Germany.
Health Policy. 2018 Jul;122(7):737-745. doi: 10.1016/j.healthpol.2018.05.013. Epub 2018 May 26.
This study compares continuity of care between Germany - a social health insurance country, and Norway - a national health service country with gatekeeping and patient lists for COPD patients before and after initial hospitalization. We also investigate how subsequent readmissions are affected.
Continuity of Care Index (COCI), Usual Provider Index (UPC) and Sequential Continuity Index (SECON) were calculated using insurance claims and national register data (2009-14). These indices were used in negative binomial and logistic regressions to estimate incident rate ratios (IRR) and odds ratios (OR) for comparing readmissions.
All continuity indices were significantly lower in Norway. One year readmissions were significantly higher in Germany, whereas 30-day rates were not. All indices measured one year after discharge were negatively associated with one-year readmissions for both countries. Significant associations between indices measured before hospitalization and readmissions were only observed in Norway - all indices for one-year readmissions and SECON for 30-day readmissions.
Our findings indicate higher continuity is associated with reductions in readmissions following initial COPD admission. This is observed both before and after hospitalization in a system with gatekeeping and patient lists, yet only after for a system lacking such arrangements. These results emphasize the need for policy strategies to further investigate and promote care continuity in order to reduce hospital readmission burden for COPD patients.
本研究比较了德国（社会保险国家）和挪威（国民健康服务国家，实行守门人和患者名单制度）在 COPD 患者初次住院前后的连续性护理，并调查了随后的再入院情况。
使用保险索赔和国家登记数据（2009-2014 年）计算连续性护理指数（COCI）、常用提供者指数（UPC）和连续顺序指数（SECON）。采用负二项式和逻辑回归分析这些指数，以估计再入院的发生率比（IRR）和比值比（OR）。
挪威的所有连续性指数均显著较低。德国的一年再入院率显著较高，而 30 天再入院率则不然。两国在出院后一年测量的所有指数均与一年再入院呈负相关。在挪威，仅在住院前测量的指数与再入院之间存在显著关联，所有一年再入院的指数和 30 天再入院的 SECON 指数均存在关联。
我们的研究结果表明，较高的连续性与 COPD 初次入院后的再入院率降低有关。这在有守门人和患者名单制度的系统中无论是在住院前还是住院后都可以观察到，但在缺乏此类安排的系统中，只有在住院后才能观察到。这些结果强调需要制定政策策略，进一步调查和促进护理连续性，以减轻 COPD 患者的住院再入院负担。
