Residential and health care transition patterns among older medicare beneficiaries over time

To describe annual care transition patterns across residential and health care settings and assess consistency in care transition patterns across years.

This retrospective cohort study used the Medicare Current Beneficiary Survey (2000-2005). The sample comprised beneficiaries aged 65 years and older (N = 57,684 person-years of observation). We defined annual care transition patterns by combining 4 types of settings: C (community), F (facility), S (skilled nursing facility-SNF), and H (hospital). We compared weighted frequencies of transition patterns across years. We counted repeated/multiple transitions that involved movement into hospital and SNF settings and compared them by demographic characteristics.

Care transition patterns remained consistent from year to year. Approximately 22% of the study population experienced a transition annually. The most frequent transition pattern was transition to the hospital and back. Care transition patterns were enormously heterogeneous with more than 230 unique patterns; approximately 1 in 4 community-dwelling (∼23%) and most facility-dwelling (∼60%) beneficiaries with at least one transition had a unique transition pattern. Beneficiaries residing in a facility were more likely to undergo multiple transitions to hospitals and SNFs compared with community-dwelling beneficiaries.

The study provides a description of annual care transition patterns across six years. Knowledge of the consistency of care transition patterns may serve as a baseline from which to compare future patterns and aid in designing interventions targeted at specific transitions.