Association between continuity of care and long-term mortality in Taiwanese first-ever stroke survivors: An 8-year cohort study

Background Continuity of care is considered to be an important principle of stroke care; however, few analyses of empirically related outcomes have been reported. Objective This study examined the correlation between the continuity of care for outpatients after a stroke event and the survival of stroke patients over the year following hospital discharge. Research design Data from the Taiwan National Health Insurance Database were used in this study. We defined stroke as the ICD-9-CM codes 430 to 437, and all patients were followed up regarding their survival for at least one year. The modified modified continuity index (MMCI) was used as the indicator of continuity of care. Cox proportional hazard models with robust sandwich variance estimates were employed to analyze the correlation between continuity of care and stroke-related death. Results A total of 9,252 stroke patients were included in the analysis. Those patients who had a high and a completed COC had a higher percentage of survival (97.25% and 95.39%) compared to the other two groups. After controlling for other variables, compared with the low-level continuity of care group, the moderate-level, high-level and completed continuity of care groups still showed a significantly lower risk of death HR (95% CI) were: 0.63 (0.49–0.80), 0.56 (0.40–0.79) and 0.50 (0.39–0.63), respectively. Conclusion Continuity of care may increase the survival among stroke patients and therefore plays an important role in management of stroke after survival.