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Quantifying posthospital care transitions in older patients
Edna Ma1, Eric A Coleman, Ron Fish
1Division of Health Care Policy and Research and the Division of Geriatric Medicine, University of Colorado Health Sciences Center, Denver, CO, USA. Eric.Coleman@uchsc.edu
Journal of the American Medical Directors Association
|February 27, 2004
Summary
Older patients frequently experience multiple care transitions after hospital discharge, particularly within the first three months. Understanding these patterns is crucial for improving patient safety and care quality across different healthcare settings.
Area of Science:
- Geriatric Care
- Health Services Research
- Healthcare Management
Background:
- Older adults often receive care across multiple healthcare settings.
- Limited research quantifies care transitions or payment-based utilization patterns.
- No prior studies examined posthospital transfers by payment method.
Purpose of the Study:
- To examine posthospital interinstitutional transfers among older patients.
- To compare transfer frequency by payment method: managed care (MC) versus fee-for-service (FFS).
- To analyze transfers to inpatient rehabilitation facilities (IRF) and skilled nursing facilities (SNF).
Main Methods:
- Prospective cohort study design.
- Followed 1055 older patients for 12 months post-acute hospital discharge.
- Utilized administrative data, chart review, nursing assessments, and patient interviews for utilization and mortality tracking.
Main Results:
- A high percentage of patients experienced multiple transfers within 3 months (65.3% MC, 75.6% FFS).
- Significant proportions had 4-6 transfers (13.8% MC, 14.6% FFS) within the initial 3 months.
- Transfer frequency decreased over the subsequent 9 months for both payment groups.
Conclusions:
- Interinstitutional transfers are common among older patients.
- Most transfers occur within the first 3 months post-discharge.
- Understanding transition patterns is vital for improving care quality and patient safety.