Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

Abstract

BACKGROUND: It is widely hypothesized that improvement in transitions of care will reduce unplanned hospital readmissions. However, the association between the Care Transitions Measure, the national quality metric for transitions of care and readmission risk, has not been established. OBJECTIVE: We aimed to determine the association between the Care Transition Measure and readmission. DESIGN: This was a single-center, prospective cohort study. PARTICIPANTS: Convenience sample of 2,963 patients enrolled in the BBridging the Divides^program, a longitudinal care management program for patients with coronary revascularization, from 2013 to 2014. Of these, 1594 (54 %) patients completed a post-discharge Care Transition Measure questionnaire. INTERVENTION: Care Transition Measure scores were collected by trained research staff blinded to study hypothesis, by telephone, within 30 days of discharge. Higher Care Transition Measure scores reflect a higher quality transition of care. MAIN MEASURES: 30-day readmission was measured. KEY RESULTS: Of the1594 patients that completed the Care Transition Measure survey, 1216 (76 %) received percutaneous coronary intervention and 378 (24 %) received coronary artery bypass grafting. Mean Care Transition Measure scores were significantly lower among patients who had a prior admission (77.2 vs. 82.1, p < 0.001) and those with ≥ 5 comorbidities (77 vs. 82.6 vs. 81.6, p < 0.001). Mean scores were significantly lower among patients who were readmitted within the percutaneous coronary intervention subgroup (73 vs. 80.9, p < 0.001) and the total study population (74.6 vs. 81.1, p < 0.001) compared to those who were not readmitted. This was not the case in the coronary artery bypass grafting subgroup (78.5 vs. 81.7, p = 0.29). After multivariable adjustment, every ten-point increase in the Care Transition Measure score was associated with a 14 % reduction in readmission risk (adjusted odds ratio 0.86, 95 % CI 0.78-0.95). CONCLUSIONS: The Care Transition Measure is strongly associated with readmissions, which strengthens its validity. However, its association with patient variables linked with readmission and its inconsistent association with readmission across clinical groups raises concerns that scores may be influenced by patient characteristics.

Care Transitions Measure Score and Coronary Revascularization Related Readmission: Ready for Primetime Use?

“…Using a non-parsimonious multivariable adjustment model, the key finding was that for every 10-point increase in the CTM-3 score (change in a response of one out of three CTM-3 questions to the next highest response category), there was a 14 % reduction in the odds of a 30-day allcause readmission. 7 This finding provides support for the role of the CTM-3 measure in predicting short-term hospital readmissions among patients receiving coronary revascularization, and its potential use in directing payments to high quality hospitals.…”

“…7 The data were obtained from a quality improvement initiative (the BBridges^) within the Christiana Care Health system in Delaware, aimed at improving the care transition experience for patients with ischemic heart disease. As part of the Bridges program, 2963 patients with ischemic heart disease (treated with either PCI, CABG or medical therapy) received systematic pre-discharge and post-discharge interventions along with individualized transitional education.…”

Care Transitions Measure and Readmissions

“…1 Their findings add to the mounting evidence questioning the predictive ability of the CTM-3 and its use as a quality indicator of care transitions.We recently compared two measures of preparedness for discharge and readmission: the CTM-3 and B-PREPARED (Brief-Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services). 2 These measures were assessed in an observational cohort of 1,239 adult patients recently hospitalized for acute coronary syndrome and/or acute decompensated heart failure.…”

“…1 Their findings add to the mounting evidence questioning the predictive ability of the CTM-3 and its use as a quality indicator of care transitions.…”

Validación del cuestionario CTM-3-modificado sobre satisfacción con la continuidad de cuidados: un estudio de cohortes

“…Los autores argumentan que la información que se pierde al utilizar la encuesta CTM-3 es pequeña, comparada con la reducción de la carga de trabajo que se ahorra al utilizar un cuestionario sensiblemente más corto. La encuesta CTM-3 fue respaldada por el Foro de Calidad Nacional e incluida en la Evaluación de Consumidor de Proveedores de Asistencia Médica y Sistemas (CAHPS) de Estados Unidos (8,9).…”