Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification

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Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification

Coleman EA, Min SJ, Chomiak A, et al. Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification. Health Serv Res. 2004;39(5):1423-1440. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361078/ . Accessed August 7, 2014. Principle Findings: 46 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. 59 episodes (8.1 percent) resulted in death. Between 13.4 percent and 25.0 percent of post-hospital 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: Post-hospital 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.

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