Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 215-351-2653 or e-mail Angela Collom at email@example.com
Transitional care is the treatment patients receive in between levels of care, or in between hospitalization and release to home. For chronically ill, older patients, transitional care strategies can reduce unnecessary use of health services and improve patient outcomes. Less is known about the benefits and harms of transitional care strategies for patients who have a new acute event. Researchers summarized 44 studies that compared usual care with transitional care strategies for adults with acute stroke or myocardial infarction (MI). The researchers evaluated four types of transitional care strategies to determine their benefits and harms on patient outcomes and the health care system. The four types of care included hospital-initiated support into home or intermediary care; hospital-based or community-based patient and family education; community-based models of support interventions; and chronic disease management models of care. The researchers found moderate-strength evidence that hospital-initiated support reduced length of stay for patients who had a stroke and low-strength evidence that hospital-initiated support reduced mortality for patients who had an MI. There was insufficient evidence about patient and family education programs and community-based support interventions.
Patient safety and cost issues related to care transitions have become a major concern of the Centers for Medicare & Medicaid Services (CMS) and other insurance providers. Ineffective patient transition from hospital to home can result in rehospitalization, adverse medical events, or death. Researchers reviewed 36 randomized, controlled trials of interventions intended to improve patient transition from hospital to primary care. They found that the most effective interventions were medication reconciliation; use of electronic records and information sharing; discharge planning; and shared involvement in follow-up by hospital and community care providers. Most interventions had positive effects. These included reduced hospital use, improvement of continuity of care, and improvement of patient status after discharge. The author of an accompanying editorial writes that a well-executed transition should include logistical arrangements, education of the patient and family, and coordination among health professionals. While more research is needed, these evidence reviews help to identify important gaps in the available research and provide a structure upon which to design future studies that will ultimately lead to the development of effective programs.