Transitional Care May Cut Risk of Hospital Readmission for Elderly Living in Long-term-care Facilities

NEW YORK (Reuters Health) – Older people living in long-term-care facilities (LTCFs) are less likely to be readmitted to hospitals and emergency departments (EDs) if they receive coordinated and continuous care as they are transferred between facilities or units.

That’s according to a new systematic review and meta-analysis that examined both quantitative and qualitative studies transitional-care interventions for LTCF residents 65 years and older.

“This is a growing population that have greater care needs and who are more likely to need hospital care than older adults living in the community,” Dr. Kelly Birtwell of the University of Manchester’s School of Health Sciences, in the U.K., told Reuters Health by email.

Previous systematic reviews have focused on transitional-care interventions for elderly patients, but did not specifically study those in LTCFs, she added. The new work also addresses more outcomes measures than earlier research.

Dr. Birtwell and her colleagues analyzed 15 quantitative studies with a total of more than 32,000 participants/records. All were published between 2002 and 2020; 10 were conducted in Australia, three in the U.S., one in Hong Kong and one in Denmark. Six were randomized control trials.

Across 14 of the studies, patients who received transitional care were 1.7 times less likely to be readmitted to the hospital or ED compared with patients in the control groups (odds ratio, 1.66; 95% CI, 1.18 to 2.35).

Hospital readmission considered separately also dropped significantly, based on 11 studies, the researchers report in JAMA Network Open. And data from three studies showed ED length of stay was significantly reduced for groups that received transitional care (standardized mean difference, -3.00; 95% CI, -3.61 to -2.39).

There were no significant differences for other outcomes, including readmissions to emergency departments, all-cause mortality, length of stay in hospital, quality of life, or functional independence (Barthel score).

Analysis of four qualitative studies “identified a broad theme of miscommunication and mismatched expectations between stakeholders,” an issue that impacted both data collection and the quality of care, the authors write.

“This theme is really crucial to the underlying issues regarding unplanned hospital admissions,” said Dr. Helen Edwards, an emeritus professor at Queensland University of Technology’s Institute of Health and Biomedical Innovation.

Dr. Edwards, who has studied the benefits of transitional care for older and high-risk patients, but was not involved in the new review, emphasized that these miscommunications highlight the need for more-tailored and resource-intensive consideration of transitional care.

“We need to get beyond what the problem is and focus more on how to deal with the problems and issues,” Dr. Edwards told Reuters Health by email.

SOURCE: JAMA Network Open, online May 4, 2022.

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