Address correspondence to Eric A. Coleman, M.D., M.P.H., Associate Professor, Divisions of Health Care Policy and Research and Geriatric Medicine, University of Colorado Health Sciences Center, 13611 East Colfax Avenue, Suite 100, Aurora, CO 80011. Sung-joon Min, A.M., Alyssa Chomiak, Ph.D., and Andrew M. Kramer, M.D., are with the Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Denver.
Posthospital Care Transitions: Patterns, Complications, and Risk Identification
Version of Record online: 26 AUG 2004
Health Services Research
Volume 39, Issue 5, pages 1449–1466, October 2004
How to Cite
Coleman, E. A., Min, S.-j., Chomiak, A. and Kramer, A. M. (2004), Posthospital Care Transitions: Patterns, Complications, and Risk Identification. Health Services Research, 39: 1449–1466. doi: 10.1111/j.1475-6773.2004.00298.x
Funding support was provided by the Paul Beeson Faculty Scholars in Aging Research, which is administered by the American Federation for Aging Research. The funding organization had no role in the design, conduct, or interpretation of the study, or the preparation of this manuscript.
- Issue online: 26 AUG 2004
- Version of Record online: 26 AUG 2004
- Systems of care;
- care transitions;
- patient safety;
- predictive index
Objectives. To (1) describe patterns of posthospital care transitions; (2) characterize these patterns as uncomplicated or complicated; (3) identify those at greatest risk for complicated transitions.
Data Sources/Study Setting. The Medicare Current Beneficiary Survey was used to identify beneficiaries aged 65 and older who were discharged from an acute care hospital in 1997–1998.
Study Design. Patterns of posthospital transfers were described over a 30-day time period following initial hospital discharge. Uncomplicated posthospital care patterns were defined as a sequence of transfers from higher-to lower-intensity care environments without recidivism, while complicated posthospital care patterns were defined as the opposite sequence of events. Indices were developed to identify patients at risk for complicated transitions.
Principal Findings. Forty-six distinct types of care patterns were observed during the 30 days following hospital discharge. Among these patterns, 444 episodes (61.2 percent) were limited to a single transfer, 130 episodes (17.9 percent) included two transfers, 62 episodes (8.5 percent) involved three transfers, and 31 episodes (4.3 percent) involved four or more transfers. Fifty-nine episodes (8.1 percent) resulted in death. Between 13.4 percent and 25.0 percent of posthospital care patterns in the 1998 sample were classified as complicated. The area under the receiver operating curve was 0.771 for a predictive index that utilized administrative data and 0.833 for an index that used a combination of administrative and self-reported data.
Conclusions. Posthospital care transitions are common among Medicare beneficiaries and patterns of care vary greatly. A significant number of beneficiaries experienced complicated care transitions—a finding that has important implications for both patient safety and cost-containment efforts. Patients at risk for complicated care patterns can be identified using data available at the time of hospital discharge.