The J-CTM-15 is a valid and reliable measure of the quality of care transitions. However, insufficient levels of predictive validity and a lack of generalizability are limitations of the current study.
Aim: Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient's perspective and identify its components. Methods: Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.Results: A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly "very good or adequate," according to COSMIN criteria. However, content validity and development were mostly "inadequate or doubtful" or not reported. The main components of included measures comprised "self-care after discharge," "providing information to the patient," "patient engagement in the care plan," and "dealing with patient's concerns." Conclusion:The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.
Hospital-to-home care is important for improving the quality of life (QOL) of patients with heart failure (HF). However, there is little evidence of outcomes regarding hospital-to-home care interventions in Japan. Thus, this integrative review aimed to identify the components and outcomes of hospital-to-home care interventions for patients with HF in Japan. Electronic databases, such as MEDLINE, CINAHL, and Ichushi-Web, were systematically searched, and all forms of hospital-to-home care interventions in Japan were examined. Studies regarding transitional care, discharge planning, home care, and disease management were included. The characteristics and results of the intervention studies were summarized. Furthermore, we analyzed the components of hospital-to-home care interventions and considered the effective interventions for patients with HF, based on statistically significant results. Ten articles including nine interventions were reviewed. The average age of intervention participants ranged from 64 to 77.5 years old, and the sample sizes in the intervention groups ranged from 11 to 192 participants. The intervention components were categorized as follows: "hospital-based components," "home-and outpatient-based components," and "both hospital-and home-based components." The main intervention components comprised structured education, lifetime counseling, and follow-ups via telephone and video calls. The clinical outcomes included readmission, mortality, and QOL, measured up to 24 months after the interventions. There was limited evidence of interventions being continued from the hospital to home, follow-up immediately after discharge, and nurse home visits in Japan. Further studies are necessary to evaluate the outcomes of patients' experiences immediately after discharge and the quality of care transition.
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