Excerpt

Health care systems are increasingly focused on efforts to reduce hospital readmissions; a wide variety of evidence exists on interventions to reduce readmissions, and national and local quality improvement efforts focused on transitional care have also been developed.

Transitional care interventions can be resource intensive, however, and can include many different components. For health systems that endeavor to improve the transitional care experience for their patients, it is a challenge to define the specific nature of interventions they should adopt, as well as which patient populations they should target.

This report broadly summarizes evidence examining the effects of transitional care interventions. In particular, the report identifies key themes that have emerged across the transitional care intervention literature that clarify which types of intervention are associated with reduced readmissions and/or mortality, whether intervention effects differ depending on the setting in which they are implemented, and whether effects differ across patient populations. Additionally, we outline potential policy implications based on the themes emerging from the evidence as well as our own clinical, research, and policy experience with transitional care within the Veterans Health Administration (VHA).

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
• BACKGROUND
• METHODS
• RESULTS
  • WHAT TRANSITIONAL CARE INTERVENTION CHARACTERISTICS ARE ASSOCIATED WITH REDUCTIONS IN READMISSION RATES?
  • DO THE EFFECTS OF TRANSITIONAL CARE INTERVENTIONS VARY DEPENDING ON THE SETTING IN WHICH THEY ARE IMPLEMENTED?
  • HOW DOES THE CHOICE OF PATIENT POPULATION TARGETED INFLUENCE THE EFFECTS OF TRANSITIONAL CARE INTERVENTIONS?
• DISCUSSION
  • SUMMARY OF FINDINGS
  • POLICY IMPLICATIONS
  • FUTURE RESEARCH AND QUALITY IMPROVEMENT WORK
  • LIMITATIONS
  • CONCLUSIONS
• REFERENCES
• APPENDIX A TABLES
• APPENDIX B SEARCH STRATEGY
• APPENDIX C FIGURES
• APPENDIX D INCLUSION/EXCLUSION CRITERIA
• APPENDIX E REVIEWER COMMENTS AND RESPONSES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center, Portland, OR, Devan Kansagara, MD, MCR, Director

Suggested citation:

Kansagara D, Chiovaro JC, Kagen D, Jencks S, Rhyne K, O'Neil M, Kondo K, Relevo R, Motu'apuaka M, Freeman M, Englander H. Transitions of care from hospital to home: a summary of systematic evidence reviews and recommendations for transitional care in the Veterans Health Administration. VA-ESP Project #05-225; 2014.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the VA Portland Health Care System, Portland, OR, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.