Effects of continuity of care on avoidable hospitalization in hypertensive patients: a retrospective analysis in high-altitudes of China

Abstract

In recent years, the hospitalization rate in China has continued to rise, with an increasing prevalence of avoidable hospitalizations. While developed countries have extensively studied avoidable hospitalization, research in China remains limited, particularly regarding the effects of continuity of care on avoidable hospitalization, which has yet to yield consistent conclusions. This evidence gap is especially relevant in high-altitude areas, where hypertension management may be challenged by hypoxia, geographic barriers, uneven medical resources, and fragmented health service delivery. The objective of this study was to investigate the effects of continuity of care on avoidable hospitalization in hypertensive patients. We used 2022–2023 claims data from basic medical insurance in three anonymized cities in high-altitude areas of China. Adults aged ≥ 18 years with at least three hospital visits for hypertension-related conditions in 2022 were included. Continuity of care in 2022 was measured by the Continuity of Care Index (COC), Usual Provider Continuity Index (UPC) and Sequential Continuity Index (SECON). Avoidable hospitalization in 2023 was identified as at least one inpatient admission with a principal diagnosis of hypertension, based on adapted AHRQ Prevention Quality Indicator criteria after applying exclusion rules for major cardiac procedures, dialysis-related chronic kidney disease, transfers, same-day admissions/discharges and missing key data. Separate multivariable logistic regression models were fitted with avoidable hospitalization as the outcome and each continuity index as the main predictor, adjusting for age, sex, ethnic, residence location, insurance type, and number of hospital visits. Among the 13,831 patients, 425 (3.1%) experienced avoidable hospitalization for hypertension. Higher continuity of care was associated with a significantly lower risk of avoidable hospitalization: COC (OR = 0.253, 95% CI: 0.164–0.383, p < 0.001), UPC (OR = 0.230, 95% CI: 0.140–0.374, p < 0.001), and SECON (OR = 0.335, 95% CI: 0.238–0.469, p < 0.001). Enhanced continuity of care is associated with reduced avoidable hospitalizations in hypertensive patients. Strengthening healthcare system capacity, improving longitudinal patient management, and fostering strong patient-physician relationships may be effective strategies to mitigate unnecessary hospitalizations.