Continuity of care eases medical expenses in chronic shoulder pain

High continuity of care (COC) helps lower medical costs among patients with chronic shoulder pain, a recent study has found.

The researchers enrolled 1,717 patients from the Health Insurance Review and Assessment Service national sample of South Korea. The Bice-Boxerman Continuity of Care Index was used to assess COC. Outcomes were the need for surgery as well as associated and direct medical costs.

COC was classified as high in 800 patients and low in the remaining 917. Both groups were comparable in terms of age, sex distribution, and comorbidities, though frozen shoulder was significantly more common in the former group at baseline, while shoulder impingement syndrome was more frequent in the latter.

Forty-one surgeries occurred during the study’s duration, most (n=40) were for rotator cuff repair. There were nearly four times as much surgeries in the low- vs high-COC groups (32 vs 9), yielding a substantial difference in incidence rates (34.89 vs 11.25 per 1,000 population). In turn, mean medical costs were higher in the low-COC group ($396.52±602.08 vs $364.43±401.36).

Notably, median medical costs were greater in the high-COC group ($236.24 vs $220.99). Trends were similar for surgery costs.

Adjusted statistical analyses revealed that high COC was correlated with a significantly lower risk of needing surgery (odds ratio [OR], 0.41, 95 percent confidence interval [CI], 0.20–0.84), and lowered direct medical costs by around 14 percent (95 percent CI, 8.12–19.66).

“[T]o our best knowledge, the present study is the first study that examines the relationship between COC and shoulder disease,” the researchers said. “Therefore, the findings in the present study could provide meaningful and useful information to clinicians, policy makers, and patients who use medical services for shoulder pain.”