Transitional care is the treatment patients receive in between levels of care, or in between hospitalization and release to home. For chronically ill, older patients, transitional care strategies can reduce unnecessary use of health services and improve patient outcomes.
Less is known about the benefits and harms of transitional care strategies for patients who have a new acute event. Researchers summarized 44 studies that compared usual care with transitional care strategies for adults with acute stroke or myocardial infarction (MI).
The researchers evaluated four types of transitional care strategies to determine their benefits and harms on patient outcomes and the health care system. The four types of care included hospital-initiated support into home or intermediary care; hospital-based or community-based patient and family education; community-based models of support interventions; and chronic disease management models of care.
The researchers found moderate-strength evidence that hospital-initiated support reduced length of stay for patients who had a stroke and low-strength evidence that hospital-initiated support reduced mortality for patients who had an MI. There was insufficient evidence about patient and family education programs and community-based support interventions.