title: So many options, where do we start? An overview of the care transitions literature.
abstract: BACKGROUND
  Health systems are faced with a large array of transitional care interventions and patient populations to whom such activities might apply.
  
  
  OBJECTIVE
  To summarize the health and utilization effects of transitional care interventions, and to identify common themes about intervention types, patient populations, or settings that modify these effects.
  
  
  METHODS
  PubMed and Cochrane Database of Systematic Reviews (January 1950-May 2014), reference lists, and technical advisors.
  
  
  METHODS
  Systematic reviews of transitional care interventions that reported hospital readmission as an outcome.
  
  
  METHODS
  We extracted transitional care procedures, patient populations, settings, readmissions, and health outcomes. We identified commonalities and compiled a narrative synthesis of emerging themes.
  
  
  RESULTS
  Among 10 reviews of mixed patient populations, there was consistent evidence that enhanced discharge planning and hospital-at-home interventions reduced readmissions. Among 7 reviews in specific patient populations, transitional care interventions reduced readmission in patients with congestive heart failure and general medical populations. In general, interventions that reduced readmission addressed multiple aspects of the care transition, extended beyond hospital stay, and had the flexibility to accommodate individual patient needs. There was insufficient evidence on how caregiver involvement, transition to sites other than home, staffing, patient selection practices, or care settings modified intervention effects.
  
  
  CONCLUSIONS
  Successful interventions are comprehensive, extend beyond hospital stay, and have the flexibility to respond to individual patient needs. The strength of evidence should be considered low because of heterogeneity in the interventions studied, patient populations, clinical settings, and implementation strategies.
authors.affiliation: Department of Medicine, VA Portland Health Care System, Portland, Oregon.|Department of Medicine, Oregon Health and Science University, Portland, Oregon.|Portland VA Evidence-based Synthesis Program, Portland, Oregon.
authors.forename: Devan
authors.initials: D
authors.lastname: Kansagara
authors.affiliation: Department of Medicine, VA Portland Health Care System, Portland, Oregon.|Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Chiovaro
authors.affiliation: Department of Medicine, VA Portland Health Care System, Portland, Oregon.|Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: David
authors.initials: D
authors.lastname: Kagen
authors.affiliation: Consultant in Healthcare Safety and Quality, Baltimore, Maryland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jencks
authors.affiliation: Department of Medicine, VA Portland Health Care System, Portland, Oregon.|Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Kerry
authors.initials: K
authors.lastname: Rhyne
authors.affiliation: Portland VA Evidence-based Synthesis Program, Portland, Oregon.
authors.forename: Maya
authors.initials: M
authors.lastname: O'Neil
authors.affiliation: Portland VA Evidence-based Synthesis Program, Portland, Oregon.
authors.forename: Karli
authors.initials: K
authors.lastname: Kondo
authors.affiliation: Portland VA Evidence-based Synthesis Program, Portland, Oregon.
authors.forename: Rose
authors.initials: R
authors.lastname: Relevo
authors.affiliation: Portland VA Evidence-based Synthesis Program, Portland, Oregon.
authors.forename: Makalapua
authors.initials: M
authors.lastname: Motu'apuaka
authors.affiliation: Department of Medicine, VA Portland Health Care System, Portland, Oregon.|Portland VA Evidence-based Synthesis Program, Portland, Oregon.
authors.forename: Michele
authors.initials: M
authors.lastname: Freeman
authors.affiliation: Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Honora
authors.initials: H
authors.lastname: Englander
mesh_terms: D017028:Caregivers; D006801:Humans; D007902:Length of Stay; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission; D000069341:Transitional Care / Q000592:standards*