title: The Effect of a Care Transition Intervention on the Patient Experience of Older Multi-Lingual Adults in the Safety Net: Results of a Randomized Controlled Trial.
abstract: BACKGROUND
  The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Care Transitions Measure (CTM-3) scores are patient experience measures used to determine hospital value-based purchasing reimbursement. Interventions to improve 30-day readmissions have met with mixed results, but less is known about their potential to improve the patient experience among older ethnically and linguistically diverse adults receiving care at safety-net hospitals. In this study, we assessed the effect of a nurse-led hospital-based care transition intervention on discharge-related patient experience in an older multilingual population of adults hospitalized at a safety-net hospital.
  
  
  METHODS
  We randomized 700 inpatients aged 55 and older at an academic urban safety-net hospital. In addition to usual care, intervention participants received inpatient visits by a language-concordant study nurse and post-discharge phone calls from a language-concordant nurse practitioner to reinforce the care plan and to address acute complaints. We measured HCAHPS nursing, medication, and discharge communication domain scores and CTM-3 scores at 30 days after hospital discharge.
  
  
  RESULTS
  Of 685 participants who survived to 30 days, 90 % (n = 616) completed follow-up interviews. The mean age was 66.2 years; over half (54.2 %) of the participants had cognitive impairment, and 33.8 % had moderate to severe depression. The majority (62.1 %) of interviews were conducted in English; 23.3 % were conducted in Chinese and 14.6 % in Spanish. Study nurses spent an average of 157 min with intervention participants. Between intervention and usual care participants, CTM-3 scores (80.5 % vs 78.5 %; p = 0.18) and HCAHPS discharge communication domain scores (74.8 % vs 68.7 %; p = 0.11) did not differ, nor did HCAHPS scores in medication (44.5 % vs 53.1 %; p = 0.13) and nursing domains (67.9 % vs 64.9 %; p = 0.43). When stratified by language, no significant differences were seen.
  
  
  CONCLUSIONS
  An inpatient standalone transition-of-care intervention did not improve patient discharge experience. Older multi-lingual and cognitively impaired populations may require higher-intensity interventions post-hospitalization to improve discharge experience outcomes.
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143-1364, USA. brian.chan@ucsf.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Chan
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143-1364, USA.
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Goldman
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143-1364, USA.
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
authors.affiliation: Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Schneidermann
authors.affiliation: Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Kessell
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143-1364, USA.
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.affiliation: Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Critchfield
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143-1364, USA.
authors.forename: Margot
authors.initials: M
authors.lastname: Kushel
mesh_terms: D000359:Aftercare / Q000458:organization & administration; D000368:Aged; D002140:California; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D009738:Nursing Service, Hospital / Q000458:organization & administration; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000458:organization & administration; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D064876:Safety-net Providers; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000523:psychology*
keywords: Patient experience; Randomized controlled trial; Transitions of care; Vulnerable populations