The impact of facility-based transitional care programs on function and discharge destination for older adults with cognitive impairment: a systematic review (original) (raw)
Related papers
Outcomes of cognitively impaired older people in Transition Care
Australasian journal on ageing, 2014
The benefits of Transition Care Programs (TCPs) for patients with cognitive impairment are not well established. This study aimed to investigate the impact of TCP on patients according to their cognitive status. In this prospective cohort study, 351 patients were comprehensively assessed at TCP admission using the interRAI Home Care instrument and divided into two groups based on scores on the Cognitive Performance Scale. Of 346 patients assessed for cognition, 242 (69.9%) were considered cognitively intact, and 104 (30.1%) were classified as cognitively impaired (Cognitive Performance Scale ≥ 2). There were no significant differences in TCP outcomes between the two groups, including community living at six months (P = 0.1), hospital readmission rates (P = 0.6), or achievement of TCP goals (P = 0.3). Cognitively intact and cognitively impaired patients have similar outcomes post-TCP. Older patients should not be refused Transition Care based on the presence of cognitive impairment.
Journal of Hospital Medicine, 2019
U nplanned hospital admissions and readmissions have become a major focus of efforts to improve the value of healthcare given that these potentially preventable events exert substantial burden on patients, caregivers, health systems, and the economy. 1 The percentage of patients who are rehospitalized within 30 days have decreased from 20%-21% at the start of the Accountable Care Act and readmission penalties to approximately 18%. 2-5 Rehospitalization rates are 33% at 90 days and approach 40% at six months. 6,7 Readmissions cost Medicare more than $26 billion annually, 4 with one in five Medicare beneficiaries readmitted within 30 days of hospital discharge. 8 Centers for Medicare and Medicaid Services and other payers use condition-specific and all-cause 30day unplanned readmission rates and potentially preventable admissions among patients with complex or multiple comorbidities for public reporting, value-based purchasing, and performance-based reimbursement. 9,10 Consequently, medical groups and hospitals have begun to place an increasing emphasis on improving the transitions of care following hospitalization with the goal of reducing unplanned readmissions. 11 Care transitions programs have been shown to decrease readmission rates, mortality, and emergency department (ED) visits. 12 Care transitions programs vary greatly in their scope of intervention and target groups, as well as in their efficacy in reducing readmissions. 13,14 The Mayo Clinic Care Transition Program, hereafter referred to as CTP, was launched in 2011. This program was modeled after other successful programs and in
Transitional care programs: who is left behind? A systematic review
International journal of integrated care
Older adults are at risk of rehospitalization if their care transitions from hospital-to-home are not properly managed. The objective of this review was to determine if older patient populations recruited for randomized controlled trials of transitional care interventions represented those at greatest risk of rehospitalization following discharge. Relevant risk factors examined were cognitive impairment, depression, polypharmacy, comorbidity, length of stay, advanced non-malignant diseases, and available social support. Systematic review. Hospital to home. Older hospitalized adults. For inclusion, articles were required to focus on hospital-to-home transitions with a self-care component, have components occurring both before and after discharge, and a randomized controlled trial design. Articles were excluded if participants had a mean age under 55 years, or if interventions focused on developmental disabilities, youth, addictions, or case management, or were solely primary-care bas...
BMJ open, 2018
An acute hospital admission is a stressful life event for older people, particularly for those with cognitive impairment. The hospitalisation is often complicated by hospital-associated geriatric syndromes, including delirium and functional loss, leading to functional decline and nursing home admission. Hospital at Home care aims to avoid hospitalisation-associated adverse outcomes in older patients with cognitive impairment by providing hospital care in the patient's own environment. This randomised, non-blinded feasibility trial aims to assess the feasibility of conducting a randomised controlled trial in terms of the recruitment, use and acceptability of Hospital at Home care for older patients with cognitive impairment. The quality of care will be evaluated and the advantages and disadvantages of the Hospital at Home care programme compared with usual hospital care. Eligible patients will be randomised either to Hospital at Home care in their own environment or usual hospita...
Trials
Background The sectorization of health-care systems leads to inefficient treatment, especially for elderly people with cognitive impairment. The transition from hospital care to primary care is insufficiently coordinated, and communication between health-care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmissions, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to compare the effectiveness of a collaborative care model with usual care for people with cognitive impairment who have been admitted to a hospital for treatment due to a somatic illness. The aim of the intervention is to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. Methods/design The trial is a longitudinal multisite randomized controlled trial with two arms (c...
BMC Geriatrics, 2021
Background Many hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs. Transitional care programs (TCPs) are designed to provide short-term and low-intensity restorative care to these older adults experiencing or at risk for delayed discharge. However, little is known about the contextual factors (i.e., patient, staff and environmental characteristics) that may influence the implementation and outcomes of TCPs. This scoping review aims to answer: 1) What are socio-demographic and/or clinical characteristics of older patients served by TCPs?; 2) What are the core components provided by TCPs?; and 3) What patient, caregiver, and health system outcomes have been investigated and what changes in these outcomes have been reported for TCPs? Methods The six-step scoping review framework and PRISMA-ScR checklist were followed. Studies were included if they presented models of TCPs and evaluated them in community-dw...
Effects of alternative interventions among hospitalized, cognitively impaired older adults
Journal of comparative effectiveness research, 2016
Compare within site effects of three interventions designed to enhance outcomes of hospitalized cognitively impaired elders. Prospective, nonrandomized, confirmatory phased study. In Phase I, 183 patients received one of three interventions: augmented standard care (ASC), resource nurse care (RNC) or Transitional Care Model (TCM). In Phase II, 205 patients received the TCM. Time to first rehospitalization or death was longer for the TCM versus ASC group (p = 0.017). Rates for total all-cause rehospitalizations and days were significantly reduced in the TCM versus ASC group (p < 0.001, both). No differences were observed between RNC versus TCM. Findings suggest the TCM is more effective than ASC. However, potential effects of the RNC relative to the TCM warrant further study.