Quality Of Transitional Care Research Articles

Application of Chinese version of Care Transitions Measure in patients with chronic diseases

Objective To apply the Chinese version of Care Transition Measure (C-CTM) in patients with chronic diseases to assess the quality of transitional care and its influencing elements in order to provide reference for improving the quality of transitional care. Methods A total of 210 patients with chronic diseases were telephoned 2 to 4 weeks after discharge using C-CTM. Results The C-CTM score of the 210 study participants was 52.37±15.45. The general self-care preparation scored the highest which was 65.48±15.07, written plan was the lowest with a median score of 16.67. Multiple regression analysis showed that education level, hospital class and Activity of Daily Living (ADL) scores upon admission were significantly positively associated with the C-CTM scores. Conclusions The overall quality of transitional care was poor, especially in written plan. Quality of transitional care was poorer in patients with lower education level, being admitted to lower class hospitals and with lower ADL scores upon admission. Key words: Transitional care; Chinese version of Care Transition Measure; Chronic diseases

Older patients' participation in hospital admissions through the emergency department: an interview study of healthcare professionals.

BackgroundPatient participation is an important aspect of healthcare quality and may be one way to improve the quality of transitional care for older patients. Research reveals minimal awareness about patient participation in hospital admissions. Hospital admissions require attention to individuals’ specific needs beyond patient frailty, and to involve patients and their families in shared decision-making. The aim of this study was to identify factors influencing patient participation by exploring healthcare professionals’ views on patient participation during the hospital admission of older patients through the emergency department (ED).MethodsThe study used a qualitative and descriptive design with face-to-face interviews. A total of 27 interviews were conducted with 15 healthcare professionals from one hospital and 12 from another. The data were analyzed using systematic text condensation.ResultsHealthcare professionals thought that patient participation in hospital admissions was influenced by five main factors: 1) routine treatment and care during hospital admission, and in particular certain procedures such as medical examinations; 2) the frail and thankful older patients, and the overall picture of their medical needs; 3) hospital resources, such as available staff and beds; 4) healthcare professionals’ attitude towards finding out about older patients’ experiences; and 5) the presence of a supportive and demanding next of kin acting as an advocate for the patient.ConclusionsPatient participation in hospital admissions of older patients is dependent on the way the service is organized, the patients’ condition, hospital resources, healthcare professionals’ attitudes, and support from patients’ next of kin. Some of the participants had high expectations of themselves and actively involved patients, but others did not find patient participation relevant in the emergency department. Some used crowded wards as a reason not to engage older patients in their own care.

Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals

Article-at-a-Glance Background: Care transitions across health care settings are common and can result in adverse outcomes for older adults. Few studies have examined health care professionals' perspectives on important process measures or pay-for-performance (P4P) strategies related to transitional care. A study was conducted to characterize health care professionals' perspectives on (1) successful transitional care of older adults (age 65 years and older), (2) suggestions for improvement, and (3) P4P strategies related to transitional care. In a qualitative study, one-hour semistructured in-depth interviews were conducted in an acute care hospital, a skilled nursing facility, two community-based primary care practices, and one home health care agency with 20 health care professionals (18 physicians and 2 home health care administrators) with direct experience in care transitions of older adults and who were likely to be affected by P4P strategies. Findings were organized into three thematic domains: (1) components and markers of effective transitional care, (2) difficulties in design and implementation of P4P strategies, and (3) health care professionals' concerns and unmet needs related to delivering optimal care during transitions. A conceptual framework was developed on the basis of the findings to guide design and implementation of P4P strategies for improving transitional care. In characterizing health care professionals' perspectives, specific care processes to target, challenges to address in the design of P4P strategies, and unmet needs to consider regarding education and feedback for health care professionals were described. Future investigations could evaluate whether performance targets, educational interventions, and implementation strategies based on this conceptual framework improve quality of transitional care.

A review of the literature on patient participation in transitions of the elderly

Patient participation is highlighted in healthcare policy documents as an important area to address in order to improve and secure healthcare quality. The literature on healthcare quality and safety furthermore reveals that transitional care carries a risk of adverse events. Elderly persons with co-morbidities are in need of treatment and healthcare from several care professionals and are transferred between different care levels. Patient-centered care, shared decision-making and user involvement are concepts of care that incorporate patient participation and the patients’ experiences with care. Even though these care concepts are highlighted in healthcare policy documents, limited knowledge exists about their use in transitions, and therefore points to a need for a review of the existing literature. The purpose of the paper is to give an overview of studies including patient participation as applied in transitional care of the elderly. The methodology used is a literature review searching electronic databases. Results show that participation from elderly in discharge planning and decision-making was low, although patients wanted to participate. Some tools were successfully implemented, but several did not stimulate patient participation. The paper has documented that improvements in quality of transitional care of elderly is called for, but has not been well explored in the research literature and a need for future research is revealed. Clinical practice should take into consideration implementing tools to support patient participation to improve the quality of transitional care of the elderly.

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...

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.

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% <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.

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.

Quality in transitional care of the elderly: Key challenges and relevant improvement measures.

Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures. Included in the study were elderly patients (75+) receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41) were carried out by two researchers. SIX MAIN CHALLENGES WITH BELONGING DESCRIPTIONS HAVE BEEN IDENTIFIED: (1) next of kin (bridging providers, advocacy, support, information brokering), (2) patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions), (3) health care personnel's competence (professional, system, awareness of others' roles), (4) information exchange (oral, written, electronic), (5) context (stability, variability, change incentives, number of patient handovers) and (6) patient assessment (complex clinical picture, patient description, clinical assessment). Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.

G46 Arrived safely? Audit of documentation of successful transfer into adult care of young people attending adolescent rheumatology clinics

Background Concerns regarding the administrative transfer of information at the paediatric and adult interface have been raised by both patients and professionals alike. Although tracking mechanisms are recommended nationally, lapse of care at time of transfer is widely reported. This includes a previous departmental audit in 2007, which revealed potential lapse of care in 25% of transferred patients. Aims Our aim was to determine the success of transfer to adult care from a paediatric rheumatology service with a coordinated transitional care programme. Methods Retrospective case note review of all transferred patients from 2007–12 at a single UK hospital. Results Data collection revealed 152 patients were transferred to 35 adult rheumatologists with 90 patients discharged to primary care. Of patients transferred, the mean age at diagnosis was 10 years (1 –16) and mean age at transfer was 17 years (16–19). 64% (n = 97) were female and 26% (n = 39) were non-caucasian. 69% (n = 105) had Juvenile idiopathic arthritis and 59% (n = 89) were on a DMARD/biologic during transfer. 37% (n = 56) had a co-morbidity. The median (mean, range) duration between last paediatric and first adult appointment was 115 days (102, 0–457). Thirteen patients were lost to follow up, including 11 with inflammatory disease, 4 with co-morbidities, and 3 on DMARD/biologic. Successful transfer, defined by receipt of a letter from first adult appointment, occurred in 86% (n = 130) of cases, and receipt of a letter from second adult appointment occurred in 43% (n = 65) of cases. Seven were currently being transferred and not included. Referral letter, health summaries, and copy letters were sent to the adult team in 76% (n = 116) of cases, and copied to 41% (n = 63) of patients. Conclusions Although there has been an improvement in transfer organisation since the previous audit, there continues to be variation within a single paediatric rheumatology service with an established transitional care programme. Further attention to the administrative workload of transition and consistency of practice within teams is required to ensure equity and quality of transitional care within centres.

Walking the talk. Implementation of transitional care guidance in a UK paediatric and a neighbouring adult facility

To examine the quality of transitional care in a paediatric and adult hospital by investigating (i) adherence to national transition guidance and (ii) whether implementation is associated with better patient/carer experiences. A cross-sectional study was conducted in a UK paediatric hospital (PH) and neighbouring adult hospital. Clinics completed a questionnaire to determine characteristics of their transitional care provision and invited patients aged 11-21 years and parents/carers to complete a questionnaire ('Mind the Gap') to assess their satisfaction. Twenty-three clinics participated. Fourteen (70%) reported delivering a transition programme, but only 5 (25%) indicated this was holistic (addressing medical, psychosocial and vocational issues). Participants included 457 young people and 330 parents, 71% and 88% respectively attending the PH. Ratings of current care were significantly lower than ratings of best care. These 'gap' scores were not excessive, although some participants were very dissatisfied. Better satisfaction was associated with attending clinics that provided transitional care, especially when defined as 'holistic' and youth-friendly. Transition programmes that adhere to current guidance are associated with better satisfaction, but variations in provision suggest barriers to implementation. Attention is required to how youth-friendly transitional care is defined with particular reference to the specific clinic model.

Quality of Discharge Practices and Patient Understanding at an Academic Medical Center

With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding. To conduct a multifaceted evaluation of transitional care from a patient-centered perspective. Prospective observational cohort study, May 2009 through April 2010. Urban, academic medical center. Patients 65 years and older discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia. Discharge practices, including presence of follow-up appointment and patient-friendly discharge instructions; patient understanding of diagnosis and follow-up appointment; and patient perceptions of and satisfaction with discharge care. The 395 enrolled patients (66.7% of those eligible) had a mean age of 77.2 years. Although 349 patients (95.6%) reported understanding the reason they had been in the hospital, only 218 patients (59.6%) were able to accurately describe their diagnosis in postdischarge interviews. Discharge instructions routinely included symptoms to watch out for (98.4%), activity instructions (97.3%), and diet advice (89.7%) in lay language; however, 99 written reasons for hospitalization (26.3%) did not use language likely to be intelligible to patients. Of the 123 patients (32.6%) discharged with a scheduled primary care or cardiology appointment, 54 (43.9%) accurately recalled details of either appointment. During postdischarge interviews, 118 patients (30.0%) reported receiving less than 1 day’s advance notice of discharge, and 246 (66.1%) reported that staff asked whether they would have the support they needed at home before discharge. Patient perceptions of discharge care quality and self-rated understanding were high, and written discharge instructions were generally comprehensive although not consistently clear. However, follow-up appointments and advance discharge planning were deficient, and patient understanding of key aspects of postdischarge care was poor. Patient perceptions and written documentation do not adequately reflect patient understanding of discharge care.

Quality and safety in transitional care of the elderly: the study protocol of a case study research design (phase 1)

IntroductionAlthough international studies have documented that patients’ transitions between care providers are associated with the risk of adverse events and uncoordinated care, research directed towards the quality and safety of...

“Did I Do as Best as the System Would Let Me?” Healthcare Professional Views on Hospital to Home Care Transitions

Patients are vulnerable to poor quality, fragmented care as they transition from hospital to home. Few studies examine the discharge process from the perspectives of multiple healthcare professionals. To understand care transitions from the perspective of diverse healthcare professionals, and identify recommendations for process improvement. Cross sectional qualitative study. Clinicians, care teams, and administrators from the inpatient general medicine services at one urban, academic hospital; two outpatient primary care clinics; and one Medicaid managed care plan. We conducted 13 focus groups and two in-depth interviews with participants prior to initiating a hospital-funded, multi-component transitional care intervention for uninsured and low-income publicly insured patients, the Care Transitions Innovation (C-TraIn). We used thematic analysis to identify emergent themes and a cross-case comparative analysis to describe variation by participant role and setting. Poor transitional care reflected healthcare system fragmentation, limiting the ability of healthcare professionals to provide optimal patient care. Lack of standardized processes, poor multidisciplinary communication within the hospital, and fragmented communication across settings led to chaotic, unsystematic transitions, poor patient outcomes, and feelings of futility and dissatisfaction among providers. Patients with complex psychosocial needs were especially vulnerable during care transitions. Recommended changes to improve transitional care included improving hospital multidisciplinary hospital rounds, clarifying accountability as patients move across settings, standardizing discharge processes, and providing additional medical staff training. Hospital to home care transitions are critical junctures that can impact health outcomes, experience of care, and costs. Transitional care quality improvement initiatives must address system fragmentation, reduce communication barriers within and between settings, and ensure adequate professional training.

Care transitions for older patients with musculoskeletal disorders: continuity from the providers’ perspective

Care transitions are a common and frequently adverse aspect of health care, resulting in a high-risk period for both care quality and patient safety. Patients who have complex care needs and undergo treatment in multiple care settings, such as older patients with musculoskeletal disorders, may be at higher risk for poor care transitions. Key informant interviews were used to gather in-depth information on transitional care issues, particularly those which impact informational continuity, from the perspective of a range of health professionals (η=17) in care settings relevant to the care continuum of older patients with hip fractures. Three transitional care themes were identified; medical complexity impacts care trajectories, larger circles of care can be both beneficial and challenging, and a variety of channels and modes are required for meaningful information exchange. Many issues cut across each care setting, and address challenges to informational continuity among and between health care providers, patients, and caregivers. Medical complexity enlarges the circle of care which challenges care continuity. There may be fundamental elements which, regardless of care setting, strengthen transitional care quality. Standardized transitional care processes might help to offset informational discontinuity across care settings as a result of this population's larger circles of care.

Transitional aged care and the patient's view of quality

This paper synthesises the literature on the issues related to the older patient, health service quality and its measurement. It discusses the need to consider these perspectives in the definition and assessment of quality of a community‐focused aged healthcare programme, and critically examines the existing evaluation of quality in healthcare, contrasting the patient's role and impact on the quality of the service and its outcome. The paper then reviews the documented problems associated with using satisfaction as an indicator of the patient's view of quality. An alternate validated approach to measuring the patient's perception of the quality of the service is identified in the services literature; this multidimensional hierarchical tool and scale, which specifically measures the patient's view of quality, is presented. The tool covers nine sub‐dimensions, four dimensions and the global perspective of quality as perceived by the patient. An adaptation of this tool is presented to measure the patient's view of quality using the relatively new Transition Aged Care programme as an example, and make the argument for the holistic measurement of transitional aged care quality, using a validated and reliable patient‐specific tool. Importantly, the paper proposes that the identification of the patient view of service quality will offer information that could specifically assist with service improvement.

Assessing the Quality of Transitional Care

The Institute of Medicine has identified care transitions as a priority area for performance measurement. To examine the performance of the Care Transitions Measure (CTM) in more diverse populations and to introduce a 3-item CTM. Cross-sectional study with purposive sampling of traditionally underserved populations. Confirmatory factor analyses, internal consistency reliability analyses, and differential item function tests were performed to explore the stability and performance of the 15-item CTM. Regression assessed the ability of the 3-item CTM to predict the 15-item CTM total score. Analysis of variance tests were conducted to explore CTM performance in different populations with respect to health and demographics. A total of 225 patients age 18-90 who were hospitalized in the past 12 months and were African American, Hispanic American, or rural-dwelling. CTM-15, CTM-3, age, gender, education, and health status. Mplus confirmatory factor analysis supported the CTM-15 factor structure in more diverse population (Comparative Fit Index [CFI] = 0.954). The 3-item CTM explained 88% of the variance in the 15-item CTM score. Differential item function analysis did not reveal any differential item difficulty by age, gender, education, self-rated health, or group (African American, Hispanic American, and rural-dwelling). Following endorsement by National Quality Forum, findings support use of the CTM in national public reporting efforts. The 3-item CTM closely approximates the 15-item instrument and may be attractive to purchasers and health care organizations that want to assess quality in this area while minimizing cost and response burden.

Patterns of Emergency Care Use in Residential Care Settings: Opportunities to Improve Quality of Transitional Care in the Elderly

SUMMARY Emergent care is a prominent feature in the complex matrix of care transitions for vulnerable elders. This article evaluates local patterns of emergent care transport using ambulance transport data for the year 2003, analyzed by residential setting (independent senior apartments, licensed residential care and nursing homes). Significant differences were found between categories and between facilities within categories (p > .001). The more than three-fold difference in ambulance transport rate between nursing homes reinforces the need to recognize these transitions as quality indicators. Differences between senior apartments and licensed residential care settings provide initial insight suggesting opportunities for quality improvement in these community settings.

The Central Role of Performance Measurement in Improving the Quality of Transitional Care

SUMMARY The objectives of this study were: (1) to demonstrate the ability of the Care Transitions Measure (CTM) to identify care deficiencies; (2) to devise and implement a quality improvement approach designed to remedy these deficiencies; (3) to assess the impact of the quality improvement approach on CTM scores; and (4) to test whether the CTM-3 predicts return to the emergency department. The CTM was found to be a sensitive tool able to capture changes in performance. The 3-item CTM was found to significantly predict post-hospital return to the emergency department within the first 30 days (p = 0.004).