Cost impact of the transitional care model for hospitalized cognitively impaired older adults

Pauly, Mark V.; Hirschman, Karen B.; Hanlon, Alexandra L.; Huang, Liming; Bowles, Kathryn H.; Bradway, Christine; McCauley, Kathleen M.; Naylor, Mary D.

doi:10.2217/cer-2018-0040

Cited by 11 publications

(17 citation statements)

References 43 publications

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“…Authorisation problems between nurses and physicians regarding who is responsible and accountable for healthcare provision are a challenge to developing quality transitional care programmes (38, 42). Transitional care interventions for older patients can be cost‐effective, but are dependent on management effectiveness of sufficient staff provision and equipment (46, 47). Considering these multiple stress factors, it is important to provide continuous support to primary and community health nurses to prevent burnout and high staff turnover rates as well as improve patient‐related communication mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Transitional ‘hospital to home’ care of older patients: healthcare professionals’ perspectives

Dolu

Naharcı

Logan

et al. 2020

Scandinavian Caring Sciences

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Background Transitional care is a key area of care provision to older people with chronic and complex health conditions and is associated with the quality of care delivered in the healthcare system. Aims This study aimed to explore the perspectives of healthcare providers, including nurses and physicians, regarding transitional care from hospital to home in an urban area of Turkey. Methods A qualitative study using a thematic analysis method was carried out. In‐depth semi‐structured interviews were held with eight clinical nurses and five general physicians involved in the provision of healthcare services to older patients in the transitional care process from hospital to home. Findings The thematic analysis of in‐depth semi‐structured interviews with 13 healthcare professionals led to the development of the following themes: ‘uninterrupted chain of care transfer’, ‘commitment to meet patient’s needs’ and ‘support and removing ambiguities’. Conclusions Key factors impacting on the quality and safety of transitional care and continuity of healthcare are communication and collaboration between healthcare staff and settings, and older patients’ as well as family caregivers’ awareness and their feelings of responsibility towards the continuity of care at home.

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Section: Discussionmentioning

confidence: 99%

Transitional ‘hospital to home’ care of older patients: healthcare professionals’ perspectives

Dolu

Naharcı

Logan

et al. 2020

Scandinavian Caring Sciences

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“…The reduction of adverse events has also been related to interventions with a multidisciplinary approach as well as communication between health professionals during the transition from patient to home [ 24 ]. The Transitional Care Model (TCM), a multicomponent, nurse-led intervention has been tested in the U.S. and has consistently shown that the intervention which is provided on average for 60 days (range 1–3 months) can increase time to first re-hospitalization or death, decrease the number of hospitalization readmissions and number of days hospitalized, decrease costs and improve patient reported outcomes [ 17 , 25 – 27 ]. The TCM features a hospital to community dwelling intervention with nine core components.…”

Section: Introductionmentioning

confidence: 99%

Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review

Morkisch¹,

Upegui-Arango

Cardona³

et al. 2020

BMC Geriatr

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Background Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components’ role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). Methods Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. Results Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). Conclusions Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.

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“…Among the studies on hospital readmission, some common characteristics among patients were identified. Among the most common pathologies, cardiovascular diseases [17][18][19][20][21] and Chronic Obstructive Pulmonary Disease (COPD) stand out.21,22 In addition, some articles selected elderly patients [23][24][25] and with LACE score (predictive readmission score) in their samples greater than or equal to ten 26 .…”

Section: Resultsmentioning

confidence: 99%

Care Transtion in Hospital Discharge for Adult Patients: Integrative Literature Review

Gheno

Pelegrini

2021

Texto contexto - enferm.

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Objective: to summarize and analyze the scientific production on care transition in the hospital discharge of adult patients. Method: integrative review, conducted from May to July 2020, in four relevant databases in the health area: Public Medline (PubMed); Scientific Electronic Library Online (SciELO); Scopus and Virtual Health Library (VHL). The analysis of the results occurred descriptively and was organized into thematic categories that emerged according to the similarity of the contents extracted from the articles. Results: 46 articles from national and international journals, with a predominance of descriptive/non-experimental studies or qualitative studies, met the inclusion criteria. Five categories were identified: discharge and post-discharge process; Continuity of post-discharge care; Benefits of care transition; Role of nurses in care transition and Experiences of patients on care transition. Hospital discharge and care transitions are interconnected processes as transitions qualify the dehospitalization process. Different strategies for continuity of care should be adopted, as they offer greater safety to the patient. Studies have shown that nurses play a fundamental role in transitions and, in Brazil, this activity still needs to gain more space. Reduced hospitalizations, mortality, hospital costs and patient satisfaction are benefits of transitions. Conclusion: care transition is an effective strategy for the care provided to the patient being discharged. It points out the need for integration between the care network and assists services in decision-making about the continuity of care on discharge.

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Cost impact of the transitional care model for hospitalized cognitively impaired older adults

Abstract: These findings suggest that the Transitional Care Model can reduce both the amount of other postacute care and the total cost of care compared with alternative services for cognitively impaired older adults. Clinicaltrials.gov : NCT00294307.

Cited by 11 publications

References 43 publications

Transitional ‘hospital to home’ care of older patients: healthcare professionals’ perspectives

Transitional ‘hospital to home’ care of older patients: healthcare professionals’ perspectives

Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review

Care Transtion in Hospital Discharge for Adult Patients: Integrative Literature Review

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