Care Transitions Measure Research Articles

Patient Experience Shows Little Relationship with Hospital Quality Management Strategies.

ObjectivesPatient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures.Materials and MethodsWe employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level.ResultsOverall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures.ConclusionThis is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services.

Validity and reliability of the Chinese version of the care transition measure.

BackgroundThe 15-item care transition measure (CTM-15) is a reliable and valid instrument assessing the quality of care transition from patients’ perspectives. The aim of this study was to evaluate the psychometric properties of the CTM-15 and the CTM-3 (a 3-item short version of the CTM-15) in Mainland China.Methodology/FindingsThis was a cross-sectional study with a convenience sample of 646 patients in a general tertiary-level hospital in Chengdu, China. The results indicated that the Cronbach’s α values of the Chinese version of the two measures were 0.90 and 0.56, and the test-retest reliability values were 0.91 and 0.87, respectively. Three factors were extracted for the CTM-15 in Chinese populations. The CTM-15 and the CTM-3 scores discriminated well between patients with and without re-hospitalization for their index condition. The CTM-15 and the CTM-3 had significant positive relationships with self-rated health status. The CTM-3 score was significantly related to the CTM-15 score, and the CTM-3 score accounted for 64.23% of the variance of the CTM-15 score.Conclusions/SignificanceThis study has demonstrated the psychometric properties of the CTM-15 and the CTM-3 in Mainland China. Although the Cronbach’s α value of the CTM-3 is suboptimal, it has exhibited high test-retest reliability, convergent validity and criterion validity. Therefore, the CTM-3 can substitute the CTM-15 as a performance measurement tool when the sample size is large enough to compensate its suboptimal reliability or the reduced response burden is a concern.

The Effect of a Care Transition Intervention on the Patient Experience of Older Multi-Lingual Adults in the Safety Net: Results of a Randomized Controlled Trial.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Care Transitions Measure (CTM-3) scores are patient experience measures used to determine hospital value-based purchasing reimbursement. Interventions to improve 30-day readmissions have met with mixed results, but less is known about their potential to improve the patient experience among older ethnically and linguistically diverse adults receiving care at safety-net hospitals. In this study, we assessed the effect of a nurse-led hospital-based care transition intervention on discharge-related patient experience in an older multilingual population of adults hospitalized at a safety-net hospital. We randomized 700 inpatients aged 55 and older at an academic urban safety-net hospital. In addition to usual care, intervention participants received inpatient visits by a language-concordant study nurse and post-discharge phone calls from a language-concordant nurse practitioner to reinforce the care plan and to address acute complaints. We measured HCAHPS nursing, medication, and discharge communication domain scores and CTM-3 scores at 30 days after hospital discharge. Of 685 participants who survived to 30 days, 90 % (n = 616) completed follow-up interviews. The mean age was 66.2 years; over half (54.2 %) of the participants had cognitive impairment, and 33.8 % had moderate to severe depression. The majority (62.1 %) of interviews were conducted in English; 23.3 % were conducted in Chinese and 14.6 % in Spanish. Study nurses spent an average of 157 min with intervention participants. Between intervention and usual care participants, CTM-3 scores (80.5 % vs 78.5 %; p = 0.18) and HCAHPS discharge communication domain scores (74.8 % vs 68.7 %; p = 0.11) did not differ, nor did HCAHPS scores in medication (44.5 % vs 53.1 %; p = 0.13) and nursing domains (67.9 % vs 64.9 %; p = 0.43). When stratified by language, no significant differences were seen. An inpatient standalone transition-of-care intervention did not improve patient discharge experience. Older multi-lingual and cognitively impaired populations may require higher-intensity interventions post-hospitalization to improve discharge experience outcomes.

Assessment of the introduction of an adolescent transition urology clinic using a validated questionnaire

Adolescents with complex urological conditions are at risk of bladder dysfunction, metabolic disturbances, neoplastic changes and deterioration in renal function. Hence they require appropriate transition to the adult service to ensure lifelong urological care is adequately provided. Barriers and difficulties to the transition process have been identified in the literature. To overcome these difficulties an Adolescent Transition Urology Clinic (ATUC) was established in 2009 where the patients are seen by a paediatric and an adult urologist, a urology nurse and if needed an adolescent gynaecologist. Our aim was to assess the ATUC and present the patient's perspective to this new service using a validated questionnaire. Data of all patients seen at the ATUC over the study period were prospectively recorded. Patients who completed the transition were contacted and asked to complete two online urological transition questionnaires: 1) The Care Transition Measure 15 (CTM-15) which is a validated questionnaire to assess the quality of care during transition from the patients' perspective. 2) The Transition Care Experience (TCE) which was created for the purpose of this study. Thirty patients attended the ATUC over 4.5 years, with 26 (87%) completing the transition to the adult urological care. Of the 26 patients there were 14 (54%) males with a mean age of 18 years. The most common underlying urological condition was neurogenic bladder (85%). Nineteen (73%) patients completed the questionnaires. Only 1 (5%) patient thought that attending the ATUC was not beneficial, 17 (89%) would recommend the ATUC to other adolescents and 9 (47%) patients considered 18 as the appropriate transition age. Overall, 74% thought that written information would have been useful and 21% considered the adult hospital as an inappropriate environment for young adults. After attending the ATUC, 2 (11%) patients thought their preferences were not met and 3 (16%) patients were not confident that they can take care of their health. Transition of patients with complex urological conditions should aim to facilitate transferring the care from the parent to the patient and preparing the adolescent to adult life by addressing their sexual and reproductive functions. Inadequate transition can have serious health consequences. On-going communication between the paediatric and the adult urologist facilitates the transition process even after the transfer of care has occurred. The CTM-15 has been considered as "the only available measure of quality of care during transition from the patients' perspective". Our study suggests that the large majority of adolescent attending the clinic are confident in looking after their complex urological condition. In addition one patient in 5 found the adult hospital environment an inappropriate place for adolescents and they would have preferred longer follow up in a children's hospital. The value of written information after clinic consultation seems to be a useful adjunct that might facilitate the complex transition process. This is the first report evaluating the transition of adolescents with complex urological conditions using a validated transition questionnaire. The combined paediatric/adult urology clinic is beneficial in addressing the patients' needs and allowing smooth transition of these complex patients to the adult service.

Abstract 20028: Improved Outcomes with IT-enabled Care Management Following Coronary Revascularization

Objective: Hospitals are increasingly responsible for the longitudinal care of patients discharged from their institution. We report preliminary results from an IT-enabled care management program for patients following coronary revascularization at a large regional medical center. Methods: The program consisted of patient education, telephonic management, and integration with community providers. The intensity of the intervention was tailored to patient risk of subsequent utilization. We used hierarchical logistic regression to compare severity-adjusted all-cause non-elective 30-day readmissions to our institution for all patients discharged in the first year (April 2013 - April 2014) with the baseline period (January 2010 - March 2013). We used mixed effects models to compare patient responses to the Care Transitions Measure-3 (CTM-3), a CMS-endorsed measure of transition quality, and the Seattle Angina Questionnaire-7 (SAQ-7) following discharge, both of which were collected as part of routine care management. Results: We enrolled 1,542 revascularized patients in the first year, including 1,188 with PCI and 354 with CABG. The overall rate of readmission for PCI was 7.5% in the baseline period and 8.0% in the intervention period. After adjusting for patient factors, the adjusted rate of readmission was 8.9% and 6.8% (adjusted RR 0.77 [0.76 - 0.78]). The unadjusted rates for CABG were 12.6 and 12.9; with adjusted rates of 13.3 and 10.8 in the baseline and intervention period, respectively (adjusted RR 0.81 [0.8 - 0.83]). The CTM-3 score improved from 67.4±13.3 to 78.8±16.8 for PCI and from 72.7±12.7 to 75±20.7 for CABG during the intervention period (p < 0.001 for both). The SAQ domains all improved significantly during the course of the program, with improvements in Quality of Life Scale from 64±27 to 92±14 for PCI and 60±34 to 92±14 (p<0.001). Conclusions: A care management program was associated with improved process and outcome measures, including significant improvements in patient-reported outcomes, when compared to historical controls. Interdisciplinary care management programs can play a significant role in improving care, including in non-integrated healthcare environments.

Do post discharge phone calls improve care transitions? A cluster-randomized trial.

ImportanceThe transition from hospital to home can expose patients to adverse events during the post discharge period. Post discharge care including phone calls may provide support for patients returning home but the impact on care transitions is unknown.ObjectiveTo examine the effect of a 72-hour post discharge phone call on the patient's transition of care experience.DesignCluster-randomized control trial.SettingUrban, academic medical center.ParticipantsGeneral medical patients age 18 and older discharged home after hospitalization.Main Outcomes and MeasuresPrimary outcome measure was the Care Transition Measure (CTM-3) score, a validated measure of the quality of care transitions. Secondary measures included self-reported adherence to medication and follow up plans, and 30-day composite of emergency department (ED) visits and hospital readmission.Results328 patients were included in the study over an 6-month period. 114 (69%) received a post discharge phone call, and 214 of all patients in the study completed the follow outcome survey (65% response rate). A small difference in CTM-3 scores was observed between the intervention and control groups (1.87 points, 95% CI 0.47–3.27, p = 0.01). Self-reported adherence to treatment plans, ED visits, and emergency readmission rates were similar between the two groups (odds ratio 0.57, 95% CI 0.13–2.45, 1.20, 95% CI 0.61–2.37, and 1.18, 95% CI 0.53–2.61, respectively).Conclusions and RelevanceA single post discharge phone call had a small impact on the quality of care transitions and no effect on hospital utilization. Higher intensity post discharge support may be required to improve the patient experience upon returning home.Trial RegistrationClinicalTrials.gov NCT01580774

Abstract 347: Psychometric Evaluation of the Care Transition Measures in a sample of ACS patients: Results from Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education (TRACE-CORE)

Objective: Quality of transitional care is associated with important health outcomes such as rehospitalization, increased medical errors, and costs. A widely used measure of the construct, the Care Transitions Measure (CTM-15), was developed and validated with relatively small samples and classical test theory approach. The short version of the measure (CTM-3) was recently included in the CAHPS® Hospital Survey. We aimed to conduct a psychometric evaluation of the CTM-15 in a large sample and evaluate whether an item response theory (IRT) based scoring would lead to better measurement precision. Methods: As part of TRACE-CORE 1545 participants were interviewed during hospitalization for ACS providing information on general health status (SF-36). At 1 month following discharge, patients completed CTM items, health utilization and care process questions. We evaluated the psychometric properties of the CTM using descriptive statistics, factor analyses, and item response theory analyses. We compared the measu...

Abstract 150: Psychosocial Factors Predict Patient Ratings of Care Transition Quality: Results from Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education (TRACE-CORE)

Background: Short hospital stays and fragmented care make the transition following hospitalization a high-risk period for ACS patients. Identified risks for rehospitalization and complications associated with transitions include demographic (e.g., older age), clinical (e.g., co-morbidities), and psychosocial (e.g., depression, lack of social support) factors. Thus, one might expect high-risk patients to receive better quality transitional care to minimize negative outcomes; alternatively, the quality of care may be yet another outcome influenced by the same risk factors. Little is known about the predictors of quality of care transitions from the patients’ perspective. Methods: We studied 1,545 TRACE-CORE patients (mean age = 62, 34% female, 78% non-Hispanic white) admitted with an ACS who completed in-hospital interviews and the Care Transition Measure (CTM) at 1 month after discharge. High quality transitions were indicated by a CTM-15 score >74. Using logistic regression models we examined the association between in-hospital demographic, clinical, and psychosocial characteristics, generic and disease specific quality of life, health literacy and numeracy, and cognitive status with high quality transitions (see Table for measures). Results: Over one-third (36%) of participants (n=552) reported high quality transitions after an ACS. Most variables or interest were associated (p < .20) with care transition quality in bivariate analyses (Table 1). After adjustment, in-hospital cognitive impairment (Odds Ratio (OR) 0.68; 95% CI 0.46, 0.98) and older age (OR 0.99; CI 0.98, 1.00) were negatively associated with reporting high care transition quality, while high levels of social support (OR 1.06; CI 1.03, 1.10) and patient activation (OR 1.46; CI 1.02, 2.09) increased the chance of reporting high care transition quality in a multivariable model. Conclusions: Older patients, those with cognitive impairment, low social support, or lower patient activation may be at risk for lower-quality transitions following hospitalization for ACS, and may benefit from extra attention and support during the transition from hospital to home. ![][1] [1]: /embed/graphic-1.gif

Patients' views on the quality of transitional care at a health insurance hospital in Alexandria, Egypt.

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. The present study aims to measure the quality of transitional care at one of the Health Insurance Hospitals in Alexandria using the Care Transition Measure (CTM) and to explore the association between the quality of care transition and patients' characteristics. The CTM was administered to 314 patients diagnosed with four chronic conditions. The measure included the following sections: (a) demographic and medicoadministrative 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 items designated 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. 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 the 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). The quality of transitional care at Health Insurance Organization hospitals is suboptimal. An adequate plan for preparing patient discharge and follow-up after discharge should be designed.

Transitions from hospital to community care: the role of patient–provider language concordance

BackgroundCultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care.MethodsThis was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit.ResultsOverall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01).ConclusionLanguage-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

Abstract 347: Psychometric Evaluation of the Care Transition Measures in a sample of ACS patients: Results from Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education (TRACE-CORE)

Objective: Quality of transitional care is associated with important health outcomes such as rehospitalization, increased medical errors, and costs. A widely used measure of the construct, the Care Transitions Measure (CTM-15), was developed and validated with relatively small samples and classical test theory approach. The short version of the measure (CTM-3) was recently included in the CAHPS® Hospital Survey. We aimed to conduct a psychometric evaluation of the CTM-15 in a large sample and evaluate whether an item response theory (IRT) based scoring would lead to better measurement precision. Methods: As part of TRACE-CORE 1545 participants were interviewed during hospitalization for ACS providing information on general health status (SF-36). At 1 month following discharge, patients completed CTM items, health utilization and care process questions. We evaluated the psychometric properties of the CTM using descriptive statistics, factor analyses, and item response theory analyses. We compared the measurement precision of CTM-15, CTM-3, and a CTM-IRT based score using relative validity (RV) coefficients. Results: Participants were 79% non-Hispanic white, 67% male, 27% with a college education or higher (27%) and average age of 62 years. The CTM scale had good internal consistency (Cronbach’s alpha=0.95), but demonstrated strong acquiescence bias (8.7% participants responded “Strongly agree”, 19% “Agree” to all 15 items) and limited score variability (5% &lt;50score). A bi-factor model with one general factor with high item loadings and four secondary factors with lower item loadings, fit the data best supporting the assumption of essential unidimensionality of the measure. Review of item characteristic curves indicated presence of non-discriminating response categories in all items. IRT based item parameters were estimated for all items, but for five of the items there was evidence for model misfit. The CTM-15 differentiated between groups of patients defined by self-reported health status, health care utilization, and care transition process indicators. Differences between groups were small (2-3 points). There was no gain in measurement precision for the scale from IRT scoring. The CTM-3 was not significantly lower for patients reporting rehospitalization or emergency department visits. Conclusion: We identified psychometric challenges of the CTM, which may limit its value in research and practice. The strong acquiescence bias in the measure leads to highly skewed, clustered scores with restricted score variance and makes it difficult to differentiate between levels of care transition quality. In the absence of guidelines on meaningfully important differences, it is hard to determine whether detected statistically significant differences in care transition quality are important. These results are in line with emerging evidence of gaps in the validity of the measure.

Abstract 150: Psychosocial Factors Predict Patient Ratings of Care Transition Quality: Results from Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education (TRACE-CORE)

Background: Short hospital stays and fragmented care make the transition following hospitalization a high-risk period for ACS patients. Identified risks for rehospitalization and complications associated with transitions include demographic (e.g., older age), clinical (e.g., co-morbidities), and psychosocial (e.g., depression, lack of social support) factors. Thus, one might expect high-risk patients to receive better quality transitional care to minimize negative outcomes; alternatively, the quality of care may be yet another outcome influenced by the same risk factors. Little is known about the predictors of quality of care transitions from the patients’ perspective. Methods: We studied 1,545 TRACE-CORE patients (mean age = 62, 34% female, 78% non-Hispanic white) admitted with an ACS who completed in-hospital interviews and the Care Transition Measure (CTM) at 1 month after discharge. High quality transitions were indicated by a CTM-15 score &gt;74. Using logistic regression models we examined the association between in-hospital demographic, clinical, and psychosocial characteristics, generic and disease specific quality of life, health literacy and numeracy, and cognitive status with high quality transitions (see Table for measures). Results: Over one-third (36%) of participants (n=552) reported high quality transitions after an ACS. Most variables or interest were associated (p &lt; .20) with care transition quality in bivariate analyses (Table 1). After adjustment, in-hospital cognitive impairment (Odds Ratio (OR) 0.68; 95% CI 0.46, 0.98) and older age (OR 0.99; CI 0.98, 1.00) were negatively associated with reporting high care transition quality, while high levels of social support (OR 1.06; CI 1.03, 1.10) and patient activation (OR 1.46; CI 1.02, 2.09) increased the chance of reporting high care transition quality in a multivariable model. Conclusions: Older patients, those with cognitive impairment, low social support, or lower patient activation may be at risk for lower-quality transitions following hospitalization for ACS, and may benefit from extra attention and support during the transition from hospital to home.

The care transitions innovation (C-TraIn) for socioeconomically disadvantaged adults: results of a cluster randomized controlled trial.

Despite growing emphasis on transitional care to reduce costs and improve quality, few studies have examined transitional care improvements in socioeconomically disadvantaged adults. It is important to consider these patients separately as many are high-utilizers, have different needs, and may have different responses to interventions. To evaluate the impact of a multicomponent transitional care improvement program on 30-day readmissions, emergency department (ED) use, transitional care quality, and mortality. Clustered randomized controlled trial conducted at a single urban academic medical center in Portland, Oregon. Three hundred eighty-two hospitalized low-income adults admitted to general medicine or cardiology who were uninsured or had public insurance. Multicomponent intervention including (1) transitional nurse coaching and education, including home visits for highest risk patients; (2) pharmacy care, including provision of 30 days of medications after discharge for those without prescription drug coverage; (3) post-hospital primary care linkages; (4) systems integration and continuous quality improvement. Primary outcomes included 30-day inpatient readmission and ED use. Readmission data were obtained using state-wide administrative data for all participants (insured and uninsured). Secondary outcomes included quality (3-item Care Transitions Measure) and mortality. Research staff administering questionnaires and assessing outcomes were blinded. There was no significant difference in 30-day readmission between C-TraIn (30/209, 14.4 %) and control patients (27/173, 16.1 %), p = 0.644, or in ED visits between C-TraIn (51/209, 24.4 %) and control (33/173, 19.6 %), p = 0.271. C-TraIn was associated with improved transitional care quality; 47.3 % (71/150) of C-TraIn patients reported a high quality transition compared to 30.3 % (36/119) control patients, odds ratio 2.17 (95 % CI 1.30-3.64). Zero C-TraIn patients died in the 30-day post-discharge period compared with five in the control group (unadjusted p = 0.02). C-TraIn did not reduce 30-day inpatient readmissions or ED use; however, it improved transitional care quality.

Psychometric evaluation of the Care Transition Measure in TRACE-CORE: do we need a better measure?

BackgroundThe quality of transitional care is associated with important health outcomes such as rehospitalization and costs. The widely used Care Transitions Measure (CTM‐15) was developed with a classic test theory approach; its short version (CTM‐3) was included in the CAHPS Hospital Survey. We conducted a psychometric evaluation of both measures and explored whether item response theory (IRT) could produce a more precise measure.Methods and ResultsAs part of the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education, 1545 participants were interviewed during an acute coronary syndrome hospitalization, providing information on general health status (Short Form‐36), CTM‐15, health utilization, and care process questions at 1 month postdischarge. We used classic and IRT analyses and compared the measurement precision of CTM‐15–, CTM‐3–, and CTM‐IRT–based score using relative validity.Participants were 79% non‐Hispanic white and 67% male, with an average age of 62 years. The CTM‐15 had good internal consistency (Cronbach's α=0.95) but demonstrated acquiescence bias (8.7% participants responded “Strongly agree” and 19% responded “Agree” to all items) and limited score variability. These problems were more pronounced for the CTM‐3. The CTM‐15 differentiated between patient groups defined by self‐reported health status, health care utilization, and care transition process indicators. Differences between groups were small (2 to 3 points). There was no gain in measurement precision from IRT scoring. The CTM‐3 was not significantly lower for patients reporting rehospitalization or emergency department visits.ConclusionWe identified psychometric challenges of the CTM, which may limit its value in research and practice. These results are in line with emerging evidence of gaps in the validity of the measure.

Can the Care Transitions Measure Predict Rehospitalization Risk or Home Health Nursing Use of Home Healthcare Patients?

The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting.

Elderly-Inpatient Care Model Delivered Mixed Results

Elderly-Inpatient Care Model Delivered Mixed Results

Hospital readmission and parent perceptions of their child's hospital discharge

To describe parent perceptions of their child's hospital discharge and assess the relationship between these perceptions and hospital readmission. A prospective study of parents surveyed with questions adapted from the care transitions measure, an adult survey that assesses components of discharge care. Participant answers, scored on a 5-point Likert scale, were compared between children who did and did not experience a readmission using a Fisher's exact test and logistic regression that accounted for patient characteristics associated with increased readmission risk, including complex chronic condition and assistance with medical technology. A tertiary-care children's hospital. A total of 348 parents surveyed following their child's hospital discharge between March and October 2010. None. Unplanned readmission within 30 days of discharge. There were 28 children (8.1%) who experienced a readmission. Children had a lower readmission rate (4.4 vs. 11.3%, P = 0.004) and lower adjusted readmission likelihood [odds ratio 0.2 (95% confidence interval 0.1, 0.6)] when their parents strongly agreed (n = 206) with the statement, 'I felt that my child was healthy enough to leave the hospital' from the index admission. Parent perceptions relating to care management responsibilities, medications, written discharge plan, warning signs and symptoms to watch for and primary care follow-up were not associated with readmission risk in multivariate analysis. Parent perception of their child's health at discharge was associated with the risk of a subsequent, unplanned readmission. Addressing concerns with this perception prior to hospital discharge may help mitigate readmission risk in children.

An intervention to improve transitions from NICU to ambulatory care: quasi-experimental study

BackgroundInfants born prematurely or with complex medical problems are surviving to discharge in growing numbers and often require significant monitoring and coordination of care in the ambulatory setting. Using Healthcare...

Evaluation of the Mobile Acute Care of the Elderly (MACE) Service

Older adults are particularly vulnerable to adverse events during hospitalization for acute medical problems. The Mobile Acute Care of the Elderly (MACE) service is a novel model of care delivered by an interdisciplinary team, designed to deliver specialized care to hospitalized older adults to improve patient outcomes. To evaluate the impact of the MACE service when compared with general medical service (usual care). Prospective, matched cohort study. The Mount Sinai Hospital, an urban tertiary acute care hospital. Patients aged 75 years or older admitted because of an acute illness to either the MACE service or usual care. Patients were matched for age, diagnosis, and ability to ambulate independently. Admission to the MACE service when compared with admission to usual care. Patient outcomes included incidence of adverse events, including falls, pressure ulcers, restraint use, and catheter-associated urinary tract infections, along with length of stay, rehospitalization within 30 days, functional status at 30 days, and patient satisfaction during care transitions, measured with the 3-item Care Transition Measure. A total of 173 matched pairs of patients were recruited. The mean (SD) age was 85.2 (5.3) and 84.7 (5.4) years in the MACE and usual-care groups, respectively. After adjustment for confounders, patients in the MACE group were less likely to experience adverse events (9.5% vs 17.0%; adjusted odds ratio, 0.11; 95% CI, 0.01-0.88; P = .04) and had shorter hospital stays (0.8 days, 95% CI, 0.7-0.9; P = .001) than patients receiving usual care. Patients in the MACE group were not less likely to have a lower rate of rehospitalization within 30 days than those in the usual-care group (odds ratio, 0.91; 95% CI, 0.39-2.10; P = .83). Functional status did not differ between the 2 groups. Care Transition Measure scores were 7.4 points (95% CI, 2.9-11.9; P = .001) higher in the MACE group. Admission to the MACE service was associated with lower rates of adverse events, shorter hospital stays, and better satisfaction. This model has the potential to improve care outcomes among hospitalized older adults. clinicaltrials.gov Identifier: NCT00927160.

Quality of hospital to community care transitions: the experience of minority patients

Care transitions are an especially vulnerable juncture in the course of patient care. Patients from ethnic minority populations face additional unique challenges during hospital to community care transitions due to language and cultural barriers, yet, this phenomenon is understudied. This study examines the quality of care transitions of minority patients (immigrants) versus the general population, and specifically assesses the association between in-hospital provider-patient communication and the quality of minority care transitions. Prospective study of older hospitalized adults. A large teaching hospital. Participants (n = 385) were patients hospitalized for non-disabling medical conditions, from one of the two groups: the general Israeli population (Hebrew speakers) or immigrants from the former Soviet Union (Russian speakers). One-month phone follow-up assessed the quality of patients' transitional care using the care transitions measure. Russian speakers rated their transitional care on average 10% lower than Hebrew speakers (54.4 versus 64.2, respectively, P = 0.002). On average, Russian speakers' ratings on the physician interpersonal-communication scale were significantly lower than Hebrew speakers' ratings. For Russian speakers, but not Hebrew speakers, the interpersonal physician communication scale was significantly positively associated with the quality of care transitions in multivariate analyses (P = 0.01), controlling for gender, education, economic status and length of stay. Minority patients experience lower quality of care transitions than the general population. Interpersonal physician-patient communication during the hospital stay is associated with better care transitions of ethnic minority patients and should be considered in efforts to improve the quality of minority patients' care transition processes.