CARE CONTINUITY AND RISK OF NURSING HOME ADMISSION: A STUDY TO INTEGRATE PRIMARY CARE AND LONG-TERM CARE FOR KOREAN OLDER ADULTS BASED ON HEALTH CLAIMS DATA

Adverse outcomes among older adults have been reported to be a significant burden in terms of medical cost and quality of life. The objective of this study was to assess the risk of all-cause mortality, nursing home admission, and medical costs; to evaluate the impact of care continuity on the outcomes; and to recommend policies that can improve integrated modes of delivering primary care and LTC services to South Korean older adults with UI. To review previous literature, PRISMA extension guidelines were used. For quantitative analysis, the NHIS-Senior cohort patient data between January 1, 2010, and December 31, 2015, were used. To study association between care continuity and adverse outcomes (all-cause mortality, nursing home admission), 30,740 participants were followed for 6 years (2010-2015). Cox proportional hazards model was used to measure the association between outcomes and explanatory variables. A generalized linear model (GLM) with γ-distributed errors and the log link function was used to examine the relationship between health costs and explanatory variables in the year of 2010. Higher continuity of care (CoC) was a protective factor of all-cause mortality (HR 0.57, 95% CI 0.43-0.76) and of nursing home admission (HR 0.60, 95% CI 0.46-0.80). Risk factors of all-cause mortality included CCI score 2 (HR 1.37, 95% CI 1.04-1.80), CCI score 3 or more (HR 2.40, 95% CI 1.88-3.07), having disability (HR 2.19, 95% CI 1.17-4.11), and current smoking (HR 1.36, 95% CI 1.04-1.76). Risk factors of nursing home admission included higher baseline score of dependency in toilet use (HR 1.22, 95% CI 1.11-1.35), cognitive dysfunction (HR 1.10, 95% CI 1.05-1.16), and BPSD score (HR 1.11, 95% CI 1.05-1.17). In the GLM analysis, higher CoC was associated with a decrease in total medical cost (-0.63, P <.0001) and in outpatient costs (-0.28, P<.001). Higher CoC predicted a reduced medical cost of $360.93 for inpatient cost (P=0.044); $23.91 for outpatient cost (P=0.008); and $569.80 for total medical cost (P=0.002) per patient in the year of 2010. By identifying high-risk groups for adverse outcomes in community settings, those with UI may be equipped with integrated way of delivering primary care and LTC