AEM Early Access 27: Capturing Emergency Department Discharge Quality with the Care Transitions Measure: A Pilot Study

Welcome to the twenty-seventh episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

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DISCUSSING (CLICK ON LINK FOR FULL TEXT, OPEN ACCESS THROUGH JUNE 30):

Capturing Emergency Department Discharge Quality with the Care Transitions Measure: A Pilot Study. Amber K. Sabbatini MD, MPH, Fiona Gallahue MD, Joshua Newson MD, Stephanie White, Thomas Gallagher MD

LISTEN NOW: AUTHOR INTERVIEW WITH Amber K. Sabbatini MD, MPH



Amber K. Sabbatini MD, MPH

Assistant Professor

Department of Emergency Medicine

University of Washington



Abstract

Background: Recent attention has been given to developing measures to capture the quality of ED transitions of care. We examined the utility of a patient-reported measure of transitional care, the Care Transitions Measure - 3 (CTM-3) in the ED setting and its association with outcomes of care after ED discharge.

Methods: Telephone survey of a convenience sample of patients 14 days after discharge from 2 emergency departments in an academic health system. Patients responded to 3 statements using a 4-point agreement scale (Strongly Disagree, Disagree, Agree, Strongly Agree): 1) "The hospital staff took my preferences and those of my family or caregiver into account when deciding what my healthcare needs would be" 2) " When I left the ER, I had a good understanding of the things I was responsible for in managing my health, and 3) "When I left the hospital, I clearly understood the purpose for taking each of my medications." Patients were also queried about outcomes after ED discharge that are known to be related to ED care transitions including medication adherence, completion of recommended follow-up and return visits to the ED. Multivariable logistic regression was used to determine the association between the CTM-3 score (on a 100-point scale) and outcomes of interest.

Results: Among 1832 patients called, 576 were reached by phone, and 410 consented and completed our survey, representing a 22.4% response rate of patients we attempted to call. A 10-point increase in the CTM-3 score (better care experiences) was associated with a 12% decrease in the odds of having an ED return visit (AOR 0.88, 95% CI 0.77-1.00) and a 45% increase in the odds of taking prescribed medications as recommended (AOR 1.45; 95% CI 1.12-1.87). There was no association between CTM-3 score and completion of follow-up.

Conclusions: The CTM-3 is associated with outcomes of care after an ED visit, including ED return visits and medication adherence, and may have utility as a patient-reported measure of ED transitions of care. This article is protected by copyright. All rights reserved.