Community-based transition programs may be less effective than hospital-based programs
Stroke patients participating in hospital-based care-transition programs spend fewer days in the hospital than those enrolled in community-based transition programs, according to a new study in the Annals of Internal Medicine.
For the study, Duke University researchers reviewed 44 studies conducted over the past 12 years on four kinds of care-transition initiatives: hospital-based support, patient and family education, community-based support, and chronic disease management. All the studies focused on patients with strokes or myocardial infarctions (MIs).
They found "moderate-strength" evidence that hospital-based transitional care programs reduce the length of stay (LOS) for stroke patients and "low-strength" evidence that they reduce mortality for MI patients.
However, the study did not find sufficient evidence that the other three care-transition initiatives reduce LOS or mortality rates. The researchers note that data on community-based programs was scare and recommend additional research into their efficacy.
The study concludes that, as the U.S. population ages, "it is imperative to have transitional care interventions proven to be effective in improving functional outcomes, facilitating transfer of care from a hospital-based system to a community-based system, and preventing rehospitalization and adverse events."
About 200 acute-care hospitals are participating in CMS's Community-based Care Transitions Program (CCTP) across 21 states, which seeks to coordinate care for Medicare beneficiaries at a high risk for hospital readmission.
The five-year program—authorized by the Affordable Care Act—will provide up to $500 million in funding to test local provider interventions that would improve care transitions and cut Medicare costs (McKinney, Modern Healthcare, 9/17 [subscription required]; Bettger et al., Annals of Internal Medicine, 9/18 [subscription required]).