Transitions through postacute and long-term care settings: patterns of use and outcomes for a national cohort of elders.
OBJECTIVE
Despite the large number of elders using postacute and long-term care services, there is little information about transitions through different settings or the impact of transitions on elders' health. This gap in knowledge is addressed by analyzing the use of postacute and long-term care settings during a 2-year interval by a nationally representative cohort of elders.


METHODS
A 2-year longitudinal record of the use of short-stay hospitals and postacute and long-term care settings was constructed for all respondents to the 1994 National Long Term Care Survey age 65 or older in 1992. Indicators of potential transition problems include emergency room visits, potentially avoidable hospital stays, and return to an institutional setting following discharge to the community.


RESULTS
Almost 18% of elders, 4.9 million persons, were admitted to or discharged from a study setting between 1992 and 1994. A sizable number of these elders (22.4%) had subsequent health care use, suggesting a possible transition problem. Transitions from acute care hospitals to paid home care represent 20.8% of all transitions and are followed by relatively high rates of potential problems.


CONCLUSIONS
This study provides new information on patterns of postacute and long-term care use and the types of transitions most likely to be followed by potential problems. The results suggest three broad strategies for improving the outcome of transitions through postacute and long-term care settings.
Murtaugh
Christopher M
CM
Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York 10001-1810, USA. cmurtaug@vnsny.org
Litke
Ann
A
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D009735:Nursing Homes / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D019467:Subacute Care / Q000706:statistics & numerical data*; D014481:United States