Associations of care continuity and care coordination with the overuse of healthcare services: a nationwide population-based study

BACKGROUND: Care continuity and care coordination have received increased attention as important ways of decreasing overuse/low-value care. Prior research has verified an association between care continuity and overuse or an association between care coordination and overuse. However, little is known about the relative influences of care continuity and care coordination on overuse. We used nationwide population-based data from Taiwan to examine the relative associations of care continuity and care coordination with overuse. METHODS: We analyzed 1,462,960 beneficiaries in 2015 randomly sampled from all people enrolled in the Taiwan National Health Insurance. Having adjusted for patient characteristics, the multivariable logistic regression model was used to examine the associations of the Continuity of Care (COC) Index and care density on overuse, using a previously validated set of 18 potentially low-value care services. RESULTS: Higher COC index was associated with lower overuse (low vs. medium: odds ratio [OR], 1.11; 95% confidence interval [CI], 1.09-1.12; high vs. medium: OR, 0.80; 95% CI, 0.795-0.813). Higher care density was associated with lower overuse (low vs. medium: OR, 1.01; 95% CI, 1.001-1.024; high vs. medium: OR, 0.88; 95% CI, 0.87-0.89). CONCLUSIONS: Increased care continuity and care coordination are associated with decreased overuse. Facilitating care continuity and care coordination may be an important strategy for reducing overuse/low-value care.