Transitional care interventions from acute care to long-term care
facilities: a systematic review
Abstract
Objectives: Older adults living in long-term care facilities (LTCFs) are
particularly at risk during transitions in care, most notably from acute
care back to their LCTF. Issues surrounding miscommunication of
information or medications are often mentioned as important challenges.
Transitional care interventions (TCi) have emerged as solutions to
improve outcomes. The objective of this review was therefore to
determine the effects of TCi on several indicators of quality of care,
clinical outcomes, healthcare services use and satisfaction among older
patients discharged from acute care to LTCFs. Methods: Medline, CINAHL,
EMBASE, Cochrane Central and Social Work Abstracts were searched. Study
selection (title/abstract, full-text), data extraction and assessment of
study quality were conducted by two independent reviewers. A narrative
synthesis of the data was performed. Results: From the 5,506 references
identified, 11 were included. Eight studies reported on quality of care:
six on medication problems, and two on advance directives. Four studies
reported on clinical outcomes: three on mortality, two on
mobility/function and one on confusion/behavioral symptoms. Seven
studies reported on healthcare services use: six on hospital
readmissions/ED visits, and five on hospital days. Three studies
reported on satisfaction with TCi. While satisfaction levels were high
with TCi, other outcomes were inconclusive. Medications problems
appeared to be the outcome most likely to benefit from TCi. Discussion:
TCi targeting the acute to long-term care transition have obtained
inconclusive results so far. More studies investigating the outcomes of
quality of care, clinical outcomes, healthcare services use are needed.