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.
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!