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

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.