More Transitions Studies, More Mediocrity

A number of studies were released this month that deserve mention—all related to care transitions.  A recurrent theme we are adjusting to, the findings ranged from disappointing to mediocre.  Two appeared in Annals of Internal Medicine (with an associated commentary), and one, a brief from Health Affairs, gives pause to policy makers and administrators as they embrace technology and human capital to avoid readmissions and improve patient satisfaction (see the links–typical :)).

Aside from hospital measurement, and inadequate data adjustments to render truth —an issue I have addressed numerous times on this blog—I find only limited evidence supporting individual, not clustered interventions in improving transitional care.  For example, medication reconciliation works, but when used simultaneously with a pharmacist, transitions coach, in a VA hospital in an urban setting, how does that help us?  On a limited budget, how does a hospital choose interventions pragmatically, and what is their interrelatedness.  Mainly, can you use one intervention without the other, a challenge even our own BOOST presents.

I do not have an answer, and based on the literature, do not hold your breath.

The first study in AIM is a systematic review titled, Transitional Care After Hospitalization for Acute Stroke or Myocardial Infarction:

Conclusion: Available evidence shows that hospital-initiated transitional care can improve some outcomes in adults hospitalized for stroke or MI. Finding additional transitional care interventions that improve functional outcomes and prevent rehospitalizations and adverse events is a high priority for the growing population of patients who have an MI or a stroke.

The second study in AIM is also a systematic review  (and similar to a Oct ’11 release): Improving Patient Handovers From Hospital to Primary Care:

Conclusion: Many interventions have positive effects on patient care. However, given the complexity of interventions and outcome measures, the literature does not permit firm conclusions about which interventions have these effects.

Finally, Health Affairs released a terrific brief on Improving Care Transitions.  Succinct and well done, I recommend it for newbies getting up to speed on the subject.

Now go read!

 

Brad Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.

Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.

Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.

He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

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