Quality of Transition of Care in a Tertiary Care Hospital: Patients’ Perspective

Abstract

Background: Persons with continuous complex care frequently require care in multiple settings. During transitions between settings, there is evidence that the quality of care is jeopardized for these patients. Objectives: The present study aims to measure the quality of transitional care at a tertiary care hospital in India using the Care Transition Measure (CTM) and to explore the association between the quality of care transition and patients’ characteristics. Materials and Methods: The CTM was administered to 314 People Living with HIV (PLHIV) in four different wards. The measure included the following sections: (a) demographic and medico-administrative characteristics of the patients age, sex, education, the number of comorbid conditions, the type of admission, length of stay (LOS), the discharge diagnosis, and hospital admissions for the same condition as for the index hospitalization in the past 3 months. (b) The CTM is composed of 15 questions administered to patients after discharge from the hospital. The measure comprises four subdimensions: critical understanding, importance of preferences, management preparation, and the existence of a written and understandable care plan. The score in the CTM ranges from 0 to 100, with lower scores indicating a lower quality of transitional care. Results: The total mean score was 42.2, with a wide range (from 0.0 to 100.0). The highest scores were attributed to the factor “Critical Understanding”, whereas lowest scores were attributed to the factor “Care plan” (52.1 vs. 20.9). The factors “Level of communication” with the medical staff, “Management Preparation”, and “Importance of preferences” had an average score of about 39.0 (38.5, 41.4, and 33.5, respectively). Patients admitted from the emergency department had significantly higher CTM scores than those admitted from the outpatient department (P=0.023). Patients with an LOS of more than 6 days had significantly higher CTM scores compared with patients with an LOS of less than 6 days (P=0.006). Patients admitted for the same diagnoses as for the index hospitalization more than three times within the previous 3 months had a significantly higher CTM score than those admitted less than three times (P=0.017). Conclusion: The quality of transitional care at study hospital is suboptimal. An adequate plan for preparing patient discharge and follow-up after discharge should be designed.