Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Chesworth, Bert

2nd Supervisor

Gutmanis, Iris

Abstract

The internationally used 15 item Care Transition Measure (CTM-15) has been primarily used to assess the care transition experience among adults transitioning from acute care to home. Although the CTM-15’s psychometric properties have been established in this population, the ability of the CTM-15 to reliably discriminate a good from a bad care transition experience among older adults (60 or more years of age) moving from an inpatient rehabilitation setting to home is unclear. The purpose of this prospective observational cohort study was to: 1) evaluate the psychometric properties of the CTM-15 when used among older adults transitioning from an inpatient rehabilitation setting to home, 2) identify the factors associated with this care transition experience, and 3) explore and compare the care transition experience of patients discharged from two different specialized clinical treatment units.

Baseline data were collected via face-to-face interviews prior to discharge, and by telephone at both 2 to 6 days and at 28 to 32 days post discharge directly from patients. Although 64 patients were consented, complete data were available from 50 patients (mean age: 80.4 years). The CTM-15 demonstrated both internal consistency (Cronbach’s alpha = 0.91 at 2 to 6 days post discharge) and test retest reliability (ICC2,2 = 0.78). Increased age, decreased function (as measured by the Functional Independence Measure), and increased length of stay were significantly associated with a poorer care transition experience. However, only 20% of the overall variance in averaged CTM-15 scores was explained. In addition, the relationship between length of stay and care transition experience differed significantly by unit.

Subject to two administrations, the CTM-15 is a reliable and valid discriminative measure of care transition experience when used with older adults transitioning from an inpatient rehabilitation setting to home. Future studies exploring such a care transition need to account for age, function, and length of stay either in the study design and/or the analysis. The observed interaction between length of stay and unit should also be further investigated.

Summary for Lay Audience

Moving from one health care setting to another may be a challenging experience for a patient. The 15 item Care Transition Measure (CTM-15) was designed to assess the care transition experience among patients going home from an acute care hospital. However, it was unknown if the CTM-15 could also be used to assess the care transition experience of older adults going home after being in a rehabilitation hospital. The goal of this observational study was to see if the CTM-15 could reliably identify the characteristics associated with a good care transition experience among older adults going home after an inpatient rehabilitation admission.

Patients were contacted three times; just before going home, and at both 2 to 6 days and at 28 to 32 days after discharge. Data on 50 people with an average age of 80.4 years showed that the CTM-15 provided reliable information on the care transition experience. People who were older, had a longer hospital admission, and who had more difficulty with their activities of daily living tended to have a worse care transition experience as measured by the CTM-15. However, on one unit, a shorter length of stay was associated with a worse care transition experience while on the other unit a longer hospital admission was associated with a poorer care transition experience. This study showed that the CTM-15, when used among older adults discharged home following an admission to a rehabilitation hospital, could reliably distinguish between those who are likely to have a good transition care experience and those who are unlikely to have a good experience. But additional research is needed to identify the reasons why the relationship between duration of hospitalization and care transition experience differed by unit.

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