Continuity of Care for Complex Health Populations: Effectiveness and Efficiency of Two Models of Hospital to Home Transfer

Abstract

<p>Objectives: To evaluate the effectiveness and efficiency of a model of transition from hospital to home compared to optimal usual care for individuals with congestive heart failure (CHF), selected as an exemplar of a complex health population. Intervention: Strategic alliance or partnership between hospital and community health care sectors focused on the transition phase to 2 weeks post hospital discharge. Implementation of an evidence-based protocol for supportive care activities are enhanced linkages with the providers and patients. Study Questions: 1: Does Transitional Care, as an example of an inter-agency service alliance, improve the health related quality of life outcomes (MLHFQ & SF-36) for individuals with CHF more than optimal usual care? 2: What were the comparative expenditures for health services utilization at 6 weeks post hospital discharge with Transitional Care versus optimal usual care for the CHF population from a societal point of view (Browne et at., Health Services Utilization Inventory)? 3: Was there a subgroup of individuals with CHF recently discharged from hospital for whom one of the approaches to care was more effective and less expensive? DESIGN: Randomized control trial with baseline (pre hospital discharge), 2 and 6 week post discharge follow-up and outcome assessment. SAMPLE & SETTING: 123 individuals with heart failure admitted to two nursing units at a tertiary university affiliated teaching hospital. (60 experimental, 63 control) RESULTS: Clinically and statistically significant improvements in emotional well-being was associated with Transitional Care with no greater expense from a societal point of view. However, there was an important difference in the types of resources used by each approach with greater use of institutionally based resources in the usual care group and more community based resources accessed by Transitional Care participants. No statistical interactions or characteristics of subgroups of participants could be identified who were better served by one approach or the other. Implications: All types of heart failure patients can benefit in measurable emotional gains in health with Transitional Care. Transitional Care is effective and the gains in outcome were achieved at no additional expense to society as a whole.</p>