The Care Transitions Measure-3 Is Only Weakly Associated with Post-discharge Outcomes: a Retrospective Cohort Study in 48,384 Albertans

McAlister, Finlay A.; Lin, Min; Bakal, Jeffrey A.; Kemp, Kyle; Quan, Hude

doi:10.1007/s11606-019-05260-8

Cited by 9 publications

(8 citation statements)

References 31 publications

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“…In contrast to these limitations, an important strength of our study is the collection of data on perceived discharge quality on the day of discharge whenever possible, with only a small minority of patients completing the survey within 7 days. This differs from other studies that also use the CTM, where data are collected weeks after discharge, 27 31 41–43 which may result in response bias, particularly if completed after a hospital readmission or ED visit.…”

Section: Discussionmentioning

confidence: 89%

“…The primary composite outcome was readmission or ED visit within 90 days of discharge from the index hospitalisation. The choice of 90 days as a follow-up interval was selected based on prior studies showing association between CTM-3 scores with postdischarge outcomes including (readmission, death and ED visits) at 90 days but not 30 days 27 28. Study data were obtained through deterministic data linkage to administrative databases (Discharge Abstract Database for readmissions and National Ambulatory Care Reporting System for ED visits).…”

Section: Methodsmentioning

confidence: 99%

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Perceived discharge quality and associations with hospital readmissions and emergency department use: a prospective cohort study

et al. 2022

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BackgroundAt hospital discharge, care is handed over from providers to patients. Discharge encounters must prepare patients to self-manage their health, but have been found to be suboptimal. Our study objectives were to describe and determine the correlates of perceived discharge quality and to explore the association between perceived discharge quality and postdischarge outcomes.MethodsWe conducted a prospective cohort study in medical inpatients admitted to a tertiary care hospital in Calgary, Canada. Perceived discharge quality was measured by the Care Transitions Measure (CTM). Linkage to administrative databases provided data for the composite outcome—90-day hospital readmission or emergency department visit. Logistic regression modelling was used to determine the association between global CTM scores, and the individual CTM components, and the composite outcome.ResultsA total of 316 patients were included in the analysis. The median CTM score was 80.0 (IQR 66.6–100.0). The distribution of CTM scores were significantly different based on comorbidity burden, with the median and maximum CTM scores being lower and the IQR being narrower, for those with six or more comorbidities compared with those with fewer comorbidities. CTM scores were not associated with the composite outcome, though a single CTM item—not understanding warning signs and symptoms—was (adjusted OR 3.46 (95% CI 1.02 to 11.73)).ConclusionPerceived quality of discharge varies based on patient burden of comorbidities. While global perceived discharge quality was not associated with postdischarge outcomes, lack of patient understanding of warning symptoms was. Discharging healthcare teams should pay special attention to these priority patient groups and specific discharge process components.

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Section: Discussionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Perceived discharge quality and associations with hospital readmissions and emergency department use: a prospective cohort study

et al. 2022

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“…Association of Care Transitions Measure-3 with post-discharge outcomes [44] To explore whether CTM-3 scores are a suitable proxy for quality of transitional care.…”

Section: Cpes-ic Dadmentioning

confidence: 99%

How to analyze and link patient experience surveys with administrative data to drive health service improvement -- examples from Alberta, Canada

Kemp

Fairie

Steele

et al. 2022

IJPDS

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The ability of hospitals and health systems to learn from those who use its services (i.e., patients and families) is crucial for quality improvement and the delivery of high-quality patient-centered care. To this end, many hospitals and health systems regularly collect survey data from patients and their families, and are engaged in activities to publicly report the results. Despite this, there has been limited research into the experiences of patients and families, and how to improve them. Since 2015, our research team has conducted a variety of studies which have explored patient experience survey data, in isolation, and in linkages with routinely-captured administrative data sets across Alberta; a Canadian province of 4.4 million residents. Via secondary analyses, these studies have shed light upon the drivers of inpatient experience, the specific aspects of care which are most correlated with one's overall experiences, and the association of elements of the patient experience with other measures, such as patient safety indicators and unplanned hospital readmissions. The aim of this paper is to provide an overview of the methods we have used, including further details about the data sets and linkage protocol. The main findings from these papers have been presented for readers and those who wish to conduct their own work in this area.

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“…Indeed, it follows that, if stress causes deleterious effects, and if hospital stays expose patients to an assortment of stressors, then hospitalisation may be contributing to these adverse patient outcomes (this is the essence of PHS). Previous research has characterised hospitalisation as a traumatic event [e.g., 21,22], even resembling interrogation [23], and has recorded that patient-reported hospital experiences are potentially associated with patient outcomes [22,[24][25][26][27]. In fact, regardless of stress, hospitalisation may be damaging for patients (particularly older adults), being a likely risk factor for cognitive decline [28,29], functional decline [30][31][32], decompensated frailty [33], and new iatrogenic disability [34,35].…”

Section: Introductionmentioning

confidence: 99%

In-hospital stress and patient outcomes: A systematic review and meta-analysis

Ford¹,

Budworth²,

Lawton³

et al. 2023

PLoS ONE

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Background Hospital inpatients are exposed to high levels of stress during hospitalisation that may increase susceptibility to major adverse health events post-hospitalisation (known as post-hospital syndrome). However, the existing evidence base has not been reviewed and the magnitude of this relationship remains unknown. Therefore, the aim of the current systematic review and meta-analysis was to: 1) synthesise existing evidence and to determine the strength of the relationship between in-hospital stress and patient outcomes, and 2) determine if this relationship differs between (i) in-hospital vs post-hospital outcomes, and (ii) subjective vs objective outcome measures. Methods A systematic search of MEDLINE, EMBASE, PsychINFO, CINAHL, and Web of Science from inception to February 2023 was conducted. Included studies reported a measure of perceived and appraised stress while in hospital, and at least one patient outcome. A random-effects model was generated to pool correlations (Pearson’s r), followed by sub-group and sensitivity analyses. The study protocol was preregistered on PROSPERO (CRD42021237017). Results A total of 10 studies, comprising 16 effects and 1,832 patients, satisfied the eligibility criteria and were included. A small-to-medium association was found: as in-hospital stress increased, patient outcomes deteriorated (r = 0.19; 95% CI: 0.12–0.26; I2 = 63.6; p < 0.001). This association was significantly stronger for (i) in-hospital versus post-hospital outcomes, and (ii) subjective versus objective outcome measures. Sensitivity analyses indicated that our findings were robust. Conclusions Higher levels of psychological stress experienced by hospital inpatients are associated with poorer patient outcomes. However, more high-quality, larger scale studies are required to better understand the association between in-hospital stressors and adverse outcomes.

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The Care Transitions Measure-3 Is Only Weakly Associated with Post-discharge Outcomes: a Retrospective Cohort Study in 48,384 Albertans

Cited by 9 publications

References 31 publications

Perceived discharge quality and associations with hospital readmissions and emergency department use: a prospective cohort study

Perceived discharge quality and associations with hospital readmissions and emergency department use: a prospective cohort study

How to analyze and link patient experience surveys with administrative data to drive health service improvement -- examples from Alberta, Canada

In-hospital stress and patient outcomes: A systematic review and meta-analysis

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