Variation in transitional care implementation patterns for older adults with stroke in Japan: A retrospective...

Area of Science:

• Health Services Research
• Stroke Care
• Hospital Administration

Background:

• Transitional care is vital for healthcare quality and patient outcomes, especially for stroke survivors.
• Understanding implementation patterns of transitional care services is crucial for optimizing patient pathways.
• Variations in transitional care delivery may be linked to hospital characteristics.

Purpose of the Study:

• To identify transitional care service implementation patterns for ischemic stroke patients in Japanese acute care hospitals.
• To examine associations between these patterns and hospital-level characteristics.
• To explore how hospital structural factors influence transitional care delivery.

Main Methods:

• Retrospective observational study using claims data from the Japan Medical Data Center.
• Analysis of 14,129 ischemic stroke patients (≥40 years) discharged between April 2022 and August 2023.
• Latent Class Analysis to identify service patterns, followed by conditional inference tree and fractional logit regression for characteristic associations.

Main Results:

• Three distinct transitional care service implementation patterns were identified.
• Two patterns focused on patient/family education and information transfer; one involved resource-intensive services like discharge planning and post-discharge coordination.
• Patterns were significantly associated with hospital bed count and patient age (P < .01), with larger hospitals implementing more comprehensive services.

Conclusions:

• Transitional care service implementation patterns differ across Japanese hospitals, influenced by structural characteristics, particularly hospital size.
• Larger hospitals demonstrate a tendency towards more comprehensive transitional care service delivery.
• Hospital structural characteristics play a role in the variation of transitional care service delivery for ischemic stroke patients.