Does Transitional Care Prevent Older Adults From Rehospitalization? A Review

Background and Purpose: A recent study showed that almost one in five patients among the Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days (Jencks, Williams, & Coleman, 2009). One of the strategies which can prevent these rehospitalizations is improving transitional care (Tsilimingras & Bates, 2008) because medical errors related to the discontinuity of care are prevalent and are likely to result in unplanned rehospitalizations (Moore, Wisnivesky, Williams, & McGinn, 2003). Among patients, older adults are especially considered to be potential beneficiaries of transitional care, considering the fact that almost 18% of older adults, 4.9 million persons, experienced one or more transitions between 1992 and 1994 (Murtaugh & Litke, 2002). Some earlier studies conducted systematic reviews to examine the effects of transitional, but most of them included all patients regardless of age, so they are too general to clarify the effects of transitional care among older adults (Crowley et al., 2011; Keenan et al., 1998; LaMantia et al., 2010). The purpose of this paper is to present a systematic review assessing the effects of transitional care on preventing older adults from rehospitalization in the U.S. To clearly explain the effects, this paper only reviewed experimental studies of transitional care of older adults.

Methods: Potential studies were identified through electronic bibliographic databases and manual searches. Electronic searches were conducted of ISI Web of Knowledge and PsycINFO. The terms to guide the electronic searches are as follows: ‘transition*' AND ‘care' AND ‘older*' or ‘elder*' AND ‘random*' or ‘experiment*'. Articles were initially reviewed if they met the following criteria: (a) transitional care services, (b) older adults, (c) a RCT design, (d) conducted in the United States, (e) published prior to April 2011 (f) published in a peer-reviewed journal, and (g) English language. Using this approach, 336 studies were initially located, and the titles were examined. Of these 336 titles, 125 abstracts were read and 19 entire articles were examined further. Through manual searches of the references of the 19 identified articles, 33 abstracts were additionally read, and 14 articles were read in full.

Results: Fourteen articles were finally selected for this review. Eight out of 14 studies showed that elderly patients who received transitional care services had fewer rehospitalization rates compared to others who received usual care. On the other hand, three out of six studies, that did not showed reduced rehospitalization rates in overall patients, reported that the effect of transitional care differed by patient characteristics such as patients' health condition or disease. Ten out of 11 studies showed that transitional care lowered overall health costs, and four out of six studies showed that patients with such care had higher life satisfaction.

Implications: The study indicates that the effects of transitional care on rehospitalization rates are not consistent even among studies which used randomized control trials. Furthermore, different effects of transitional care between subgroups imply that more rigorous studies are needed to maximize the effects of transitional care and to provide proper treatment for patients.