Does Transitional Care Prevent Older Adults from Rehospitalization? A Review

References

• Coleman, E. A., & Boult, C. (2003). Improving the quality of transitional care for persons with complex care needs. Journal of the American Geriatrics Society, 51, 556–557.
   PubMed Web of Science ®Google Scholar
• *Coleman, E. A., Parry, C., Chalmers, S., & Min, S.-J. (2006). The care transitions intervention: Results of a randomized controlled trial. Archives of Internal Medicine, 166, 1822–1828.
   PubMed Web of Science ®Google Scholar
• Crowley, R., Wolfe, I., Lock, K., & McKee, M. (2011). Improving the transition between paediatric and adult healthcare: A systematic review. Archives of Disease in Childhood. Advance online publication. doi:10.1136/adc.2010.202473.
   Google Scholar
• DeFrances, C. J., & Podgornik, M. N. (2006). 2004 National hospital discharge survey. Advance Data, 371, 1–19.
   PubMedGoogle Scholar
• Forster, A. J., Murff, H. J., Peterson, J. F., Gandhi, T. K., & Bates, D. W. (2003). The incidence and severity of adverse events affecting patients after discharge from the hospital. Annals Internal Medicine, 138, 161–167.
   PubMed Web of Science ®Google Scholar
• He, W., Sengupta, M., Velkoff, V. A., & DeBarros, K. A. (2005). 65+ in the United States: 2005. U.S. Census Bureau: Current Population Reports. Retrieved from http://www.census.gov/prod/2006pubs/p23-209.pdf.
   Google Scholar
• Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, 360, 1418–1428.
   PubMed Web of Science ®Google Scholar
• Keenan, S. P., Massel, D., Inman, K. J., & Sibbald, W. J. (1998). A systematic review of the cost-effectiveness of noncardiac transitional care units. Chest, 113, 172–177.
   PubMedGoogle Scholar
• *Koehler, B. E., Richter, K. M., Youngblood, L., Cohen, B. A., Prengler, I. D., Cheng, D., & Masica, A. L. (2009). Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. Journal of Hospital medicine, 4, 211–218.
   PubMed Web of Science ®Google Scholar
• LaMantia, M. A., Scheunemann, L. P., Viera, A. J., Busby-Whitehead, J., & Hanson, L. C. (2010). Interventions to improve transitional care between nursing homes and hospitals: A systematic review. Journal of the American Geriatrics Society, 58, 777–782.
   PubMed Web of Science ®Google Scholar
• Masica, A. L. (2009). Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. Journal of Hospital Medicine, 4, 211–218.
   PubMedGoogle Scholar
• Misky, G. J., Wald, H. L., & Coleman, E. A. (2010). Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up. Journal of Hospital Medicine, 5, 392–397.
   PubMed Web of Science ®Google Scholar
• Moore, C., Wisnivesky, J., Williams, S., & McGinn, T. (2003). Medical errors related to discontinuity of care from an inpatient to an outpatient Setting. Journal of General Internal Medicine, 18, 646–651.
   PubMed Web of Science ®Google Scholar
• Murtaugh, C. M., & Litke, A. (2002). Transitions through postacute and long-term care settings: Patterns of use and outcomes for a national cohort of elders. Medical Care, 40, 227–236.
   PubMed Web of Science ®Google Scholar
• Naylor, M. D. (2002). Transitional care of older adults. Annual Review of Nursing Research, 20, 127–147.
   PubMedGoogle Scholar
• *Naylor, M. D., Brooten, D. A., Jones, R., Lavizzo-Mourey, R., Mezey, M. D., & Pauly, M. V. (1994). Comprehensive discharge planning for the hospitalized elderly: A randomized controlled trial. Annals of Internal Medicine, 120, 999–1006.
   PubMed Web of Science ®Google Scholar
• *Naylor, M. D., Brooten, D. A., Campbell, R. L., Jacobsen, B., Mezey, M. D., Pauly, M. V., & Schwartz, J. S. (1999). Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA, 281, 613–620.
   PubMed Web of Science ®Google Scholar
• *Naylor, M. D., Brooten, D. A., Campbell, R. L., Maislin, G., McCauley, K. M., & Schwartz, J. S. (2004). Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial. Journal of the American Geriatrics Society, 52, 675–684.
   PubMed Web of Science ®Google Scholar
• *Parry, C., Min, S.-J., Chugh, A., Chalmers, S., & Coleman, E. A. (2009). Further application of the care transitions intervention: Results of a randomized controlled trial conducted in a fee-for-service setting. Home Health Care Services Quarterly, 28, 84–99.
   PubMedGoogle Scholar
• *Peikes, D., Chen, A., Schore, J., & Brown, R. (2009). Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA, 301, 603–618.
   PubMed Web of Science ®Google Scholar
• Phillips, C. O., Wright, S. M., Kern, D. E., Singa, R. M., Shepperd, S., & Rubin, H. R. (2004). Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: A meta-analysis. JAMA, 291, 1358–1367.
   PubMed Web of Science ®Google Scholar
• Popejoy, L. L., Moylan, K., & Galambos, C. (2009). A review of discharge planning research of older adults 1990–2008. Western Journal of Nursing Research, 31, 923–947.
   PubMed Web of Science ®Google Scholar
• *Rich, M. W., Beckham, V., Wittenberg, C., Leven, C. L., Freedland, K. E., & Carney, R. M. (1995). A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. The New England Journal of Medicine, 333, 1190–1195.
   PubMed Web of Science ®Google Scholar
• *Rich, M. W., Vinson, J. M., Sperry, J. C., Shah, A. S., Spinner, L. R., Chung, M. K., & Davila-Roman, V. (1993). Prevention of readmission in elderly patients with congestive heart failure: Results of a prospective, randomized pilot study. Journal of General Internal Medicine, 8, 585–590.
   PubMedGoogle Scholar
• Snow, V., Beck, D., Budnitz, T., Miller, D. C., Potter, J., Wears, R. L., Weiss, K. B., & Williams, M. V. (2009). Transitions of care consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society of Academic Emergency Medicine. Journal of Hospital Medicine, 4, 364–370.
   PubMed Web of Science ®Google Scholar
• Tsilimingras, D., & Bates, D. W. (2008). Addressing postdischarge adverse events: A neglected area. The Joint Commission Journal on Quality and Patient Safety, 34, 85–97.
   PubMedGoogle Scholar
• Walraven, C., Mamdani, M., Fang, J., & Austin, P. C. (2004). Continuity of care and patient outcomes after hospital discharge. Journal of General Internal Medicine, 19, 624–645.
   PubMedGoogle Scholar