Quantifying posthospital care transitions in older patients.

Background Older patients frequently receive care in multiple settings. However, there has been a paucity of studies that quantify the number of care transitions or that attempt to explain utilization patterns over a given time period. Furthermore, no studies have examined transitions based on method of payment. Objective The objective of this study was to examine the number of different posthospital interinstitutional transfers (including hospital, inpatient rehabilitation facilities [IRF], and skilled nursing facilities [SNF]) by method of payment (managed Care [MC] or fee-for-service [FFS]). Design Prospective cohort followed for 12 months. Method A total of 1055 older patients were identified on transfer from an acute hospital to either an SNF or IRF. Utilization and mortality was tracked over 12 months through analysis of administrative data, chart review, nursing assessments, and patient interviews. Results After 3 months, 65.3% of MC patients and 75.6% of FFS patients experienced between two and three transfers and an additional 13.8% of MC patients and 14.6% of FFS patients experienced between four and six transfers. Over the next 9 months, the frequency of patient transfers uniformly declined in both payment groups. Conclusion This study demonstrates that interinstitutional transfers are common in older patients. The majority of these transfers occurred within the first 3 months after hospital discharge for both payment groups. Understanding the frequency and patterns of posthospital care transitions is an important step toward designing innovative approaches to improve the quality of care transitions and ensuring patient safety across settings.