The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review

Abstract

Key summary points Aim This scoping review examined the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Findings While some studies report positive outcomes on hospital utilisation, the evidence is limited for their effectiveness on emergency department attendances, institutionalisation, function, and cost-effectiveness. Message Intermediate care including transitional care interventions were associated with reduced hospital stay but this finding was not universal. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users.

The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective

“…Intermediate care, which has been developed to foster the integration between acute and PHC and provides a wide range of both health and social services to bridge care for older and frail persons who have complex needs (128), could foster the management of complex needs of frail adults. It has been shown to influence healthcare outcomes including hospitalizations, though further study particularly at population-level is required (129). Hence, while it has been said that "complex problems require complex solutions" (130), we assert that complex needs require holistic and integrated care.…”

Characteristics and mortality rates among patients requiring intermediate care: a national cohort study using linked databases

“…The provision of palliative care is a commonly cited function of intermediate care units nationally [10] and internationally, but provision varies widely depending on service commissioning and if palliative care is formally recognised in the wider health system [11]. Sezgin et al's systematic review identified these settings as delivering key elements of an effective model of care for older people with multimorbidity [8]. Key elements include the presence of a multidisciplinary team to provide a single-point of entry for multiple interventions from self-management of chronic disease, recovery and rehabilitation, to palliative and end of life care [8].…”

“…They care increasingly for a mainly older population to provide time-limited transitional care between different levels of care and settings, for example, acute hospital and home. Care focuses on supporting recovery and function following points of decline with emphasis on comprehensive geriatric assessment, enablement and rehabilitation [8,9]. These units are generally small (≤ 30 beds) [10] and provide subacute services tailored to the needs of the local population with varying access to specialist services such as a geriatrician, alongside the core staff [8,9].…”

“…Care focuses on supporting recovery and function following points of decline with emphasis on comprehensive geriatric assessment, enablement and rehabilitation [8,9]. These units are generally small (≤ 30 beds) [10] and provide subacute services tailored to the needs of the local population with varying access to specialist services such as a geriatrician, alongside the core staff [8,9]. Patients and family carers describe these facilities positively placing particular value on location close to home that enables holistic and personalised care facilitated by multidisciplinary team working and support for difficult psychological transitions, for example, loss of independence with disease progression [10].…”

“…Patients and family carers describe these facilities positively placing particular value on location close to home that enables holistic and personalised care facilitated by multidisciplinary team working and support for difficult psychological transitions, for example, loss of independence with disease progression [10]. Systematic review evidence demonstrates that compared with acute hospital care, patients and family carers in intermediate care units report better experiences and care is cost-effective to support post-acute recovery and rehabilitation [8,11]. However, less considered is risk of end of life and the need for care orientated towards quality of life and comprehensive palliative care assessment.…”