• Finlay A McAlister, Mu Lin, Jeff Bakal, Kyle A Kemp, and Hude Quan.
• Division of General Internal Medicine, University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca.
• J Gen Intern Med. 2019 Nov 1; 34 (11): 2497-2504.

BackgroundThe National Quality Forum endorsed a 3-item Care Transitions Measure (CTM-3), part of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, for evaluating hospital care transitions performance.ObjectiveTo explore whether CTM-3 scores are a suitable proxy for quality of transitional care.DesignRetrospective cohort study.ParticipantsA random sample of 48,384 adults discharged from medical or surgical wards in all 113 acute care hospitals in Alberta, Canada, between April 2011 and March 2016.Main MeasuresCTM-3 scores and their associations with all-cause emergency department (ED) visits or non-elective readmissions at 30 days, 3 months, and 12 months anywhere in the province.ResultsCTM-3 scores were significantly lower (all p < 0.01) for females, older patients, those discharged from medical wards or teaching hospitals, and those with longer length of stay, higher Charlson scores, prior ED visits/hospitalizations, or who did not return to independent living after discharge. CTM-3 scores were not significantly associated with outcomes at 30 days (mean score 77.5 in those who subsequently had an ED visit/readmission vs. 77.9 in those who did not, p = 0.13, aOR 0.99, 95% CI 0.99-0.99). Although CTM-3 scores were significantly lower in patients who subsequently had ED visit/readmission at 3 months (77.5 vs. 78.5) and 12 months (77.6 vs. 79.5), the magnitude of risk was small: for every 10 point decrease in the CTM-3 score, the risk of ED visit/readmission was 2.6% higher (aOR 1.03, 95% CI 1.01-1.05) at 3 months and 4.0% higher (aOR 1.04, 95% CI 1.01-1.08) at 12 months.ConclusionsThe CTM-3 score is influenced by baseline patient and hospital factors, is not associated with 30-day post-discharge outcomes, and is only weakly associated with 3- and 12-month outcomes. These findings suggest that the CTM-3 score is not a good performance measure for the quality of transitional care.

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