Effectiveness of early care information transfer among home-dwelling frail elderly patients in Japan: A cluster randomized trial

Abstract

Introduction Challenges are often observed during care transitions from home to hospital among frail elderly individuals who tend to be treated by different providers. This study evaluated the effectiveness of early care information transfer on the quality of care transitions among home-dwelling elderly patients in Japan who needed acute hospitalization. Methods A cluster randomized controlled trial with a clinic as a clustering unit was conducted with patients aged 65 years and older who had home-visit care and then needed to be hospitalized for acute care. The main outcomes were the quality of care transition perceived by the patient, measured by a self-administered questionnaire, and patient satisfaction, measured by the Hospital Patient Satisfaction Questionnaire. Multilevel regression analysis was used to adjust for clustering and covariates. Results Among 177 patients (78 patients in the intervention group vs. 99 patients in the control group) from 17 clinics (8 vs. 9 clinics) who were admitted to hospitals during the study period, 112 patients with main outcomes were included in the analysis (45 patients vs. 67 patients). Quality of care transition was not statistically significantly different between groups (understanding of home care situations: 58.8 vs. 58.2, p = 0.88; preference on where to be cared for: 58.1 vs. 59.6, p = 0.67; goal for discharge: 71.9 vs. 70.9, p = 0.79; care coordination: 66.3 vs. 63.8, p = 0.56). Discussion Early care referral in care transition did not show effectiveness in the quality of care transition and patient satisfaction. Studies on information-sharing in the care transition from home to hospitals are needed.