Quality and Safety Indicators for Care Transitions by Older Adults: A Scoping Review

Rangika L Fernando; Maria C Inacio; Janet K Sluggett; Stephanie A Ward; Elizabeth Beattie; Jyoti Khadka; Gillian E Caughey; Aged Care Quality Measurement Toolbox (ACAC-QMET) Research Collaborators

doi:10.1016/j.jamda.2024.105424

Quality and Safety Indicators for Care Transitions by Older Adults: A Scoping Review

J Am Med Dir Assoc. 2024 Dec 17:105424. doi: 10.1016/j.jamda.2024.105424. Online ahead of print.

Authors

Rangika L Fernando¹, Maria C Inacio², Janet K Sluggett³, Stephanie A Ward⁴, Elizabeth Beattie⁵, Jyoti Khadka⁶, Gillian E Caughey⁷; Aged Care Quality Measurement Toolbox (ACAC-QMET) Research Collaborators

Affiliations

¹ Registry of Senior Australians (ROSA) Research Centre, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia; Registry of Senior Australians (ROSA) Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia. Electronic address: [email protected].
² Registry of Senior Australians (ROSA) Research Centre, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia; Registry of Senior Australians (ROSA) Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
³ Registry of Senior Australians (ROSA) Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
⁴ Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
⁶ Registry of Senior Australians (ROSA) Research Centre, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia; Registry of Senior Australians (ROSA) Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
⁷ Registry of Senior Australians (ROSA) Research Centre, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia; Registry of Senior Australians (ROSA) Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.

PMID: 39706576
DOI: 10.1016/j.jamda.2024.105424

Abstract

Objective: To identify quality and safety indicators routinely used to monitor, evaluate, and improve care transitions for older adults globally.

Design: A scoping literature review.

Setting and participants: This review identified indicators used internationally to monitor and evaluate the quality and safety of care transitions by older adults. Care transitions were defined as the transfer of health care at least once between care settings.

Methods: A search of academic and gray literature identified indicators that were publicly available, used routinely at the population level, and reported on since 2012. Indicators were summarized by care domain (ie, hospitalization, consumer experience, access/waiting times, communication, follow-up, and medication-related), type (structure, process, outcome), quality dimension (patient centeredness, timeliness, effectiveness, efficiency, safety, and equity), data collection approach, reporting strategies, and care settings involved.

Results: The review identified 361 quality indicators from 89 programs across 12 countries. Care domains included hospitalization (N = 112; 31.0%), consumer experience (N = 82; 22.7%), access/waiting times (N = 63; 17.5%), communication (N = 40; 11.1%), follow-up (N = 40; 11.1%), and medication-related (N = 24; 6.6%). Indicators measured outcomes (N = 227; 62.9%) or processes (N = 134; 37.1%) and represented the dimensions of patient centeredness (N = 155, 42.9%), timeliness (N = 91; 25.2%), and effectiveness (N = 87; 24.1%), efficiency (N = 18; 5.0%) and safety (N = 10; 2.8%). Most indicators were constructed from survey (N = 160; 44.3%) or administrative data (N = 138; 38.2%); 69% (N = 249) were publicly reported and 80% (N = 287) measured transitions related to acute settings.

Conclusions and implications: Eighty-nine international programs routinely monitor the quality and safety of care transitions, and focus on the domains of hospitalization, access and waiting times, and communication. Considering the vulnerability of older adults as they transition across settings and providers, it is important to ensure holistic measurement of the quality of these care transitions to identify sub-optimal transitions, inform quality improvement, and ultimately improve outcomes for older adults.

Keywords: Care transitions; older adults; quality indicators; quality of health care.

Publication types

Review