Better Transitional Care Can Reduce Hospital Readmissions: Study

A recent study points to the value of transitional care interventions to keep older adults in long-term care facilities from being readmitted to the hospital.

Researchers from the University of Manchester in the United Kingdom examined quantitative and qualitative studies from the U.S. and other countries. They found that improved transition care from one care setting to another can sharply reduce the likelihood of another trip to the hospital for residents of long-term care facilities who are 65 and older.

The researchers also suggested greater investment in transitional care would be prudent, since most countries aren’t putting enough resources in that area.

The study, which was published last month by Jama Network Open, examined studies involving more than 32,000 participants.

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Notably, people who received transitional care interventions were 1.7 times less likely to be readmitted to the hospital or emergency department. Those who received interventions “experienced significantly fewer hospital readmissions” and spent less time in the emergency department, the researchers said.

“Older people living in LTCFs (long-term care facilities) experience fewer readmissions after their participation in transitional care interventions compared with usual care,” the authors wrote.  “It is therefore essential to invest in transitional care interventions owing to the high human and financial cost of avoidable readmissions in this vulnerable group of people.”

Despite the success, the researchers noted, “investment in such interventions has been remarkably low across most countries.”

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Healthcare leaders and federal officials have been pushing to reduce readmissions, which are taxing for patients and costly for the health system. U.S. Medicare readmissions cost $24 billion annually, and unplanned readmissions cost $17.4 billion, the authors noted.

Among residents of long-term care facilities, two-thirds (67%) of hospitalizations are potentially avoidable, the study noted. Complications such as infections, pressure ulcers and delirium can lead to return trips to the emergency department.

The researchers examined data from Australia, the United States, Hong Kong and Denmark. The mean age of the participants ranged from 75 to 90.

The authors noted that improving the quality of care for older people in long-term care facilities who move from one level of care to another “is a major challenge for health care systems in most developed countries.”

“Quality transitional care has several dimensions, including communication between health care professionals around discharge assessment and care planning, preparation of the patient and caregiver for care transition, timely and complete exchange of information between all parties (staff in different settings, patients, family caregivers), staff training, and patient and caregiver education on self-management,” the authors wrote.

The authors noted some limitations in their research. They noted the quality of some of the studies they examined in their meta-analysis was low.

In addition, there were some instances of poor data reporting, including data on adverse events. The authors said they would have liked more data on adverse events, since nearly 4 in 10 transfers from hospitals to long-term care facilities have associated adverse events, and more than 70% of those events could have been prevented or at least improved.

Still, the authors said their study, to the best of their knowledge, is the first systematic review of transitional care interventions among older residents of long-term care facilities that used meta-analysis and the qualitative studies.

There’s a growing need to offer improved care for seniors. Globally, the population of those 65 and older is expected to double, to 1.5 billion, by 2050.

The authors concluded with a call for putting more resources in transitional care interventions.

“Most developed countries with aging populations, including the US, Europe, and UK, have no national policy or investment in transitional care interventions for people living in LTCFs,” the authors wrote.

The authors called for developing interventions that include the availability of technology and infrastructure, the quality of communication and clear roles and expectations for workers in different care settings. Those interventions should be shown to improve outcomes set forth by patients and healthcare systems.