Hospital-initiated transition interventions may improve stroke, MI outcomes

Transition-of-care interventions initiated in the hospital can help improve outcomes in adult patients with stroke and myocardial infarction (MI), according to a new study.

Researchers performed a systematic review of studies published from January 2000 to March 2012 to examine whether transitional care interventions led to benefit or harms in patients who were hospitalized for acute stroke or MI. Observational studies or trials were included if they were in English, compared transitional and usual care in adults with the conditions of interest, and reported patient, caregiver, process or systems outcomes within one year of discharge from the hospital. Data were extracted on study design, population, quality, intervention, and patient- and system-level outcomes. Results were published in the Sept. 18 Annals of Internal Medicine.

The review included 62 articles involving 44 studies, 27 of acute stroke and 17 of MI. A total of four intervention categories were studied: hospital-initiated support (14 trials), patient and family education (7 trials), community-based support (20 trials) and chronic disease management (3 trials). Sixty-eight percent of the studies were judged to be of fair quality.

All of the transitions were from a hospital or from inpatient rehab to patients' homes. Moderate-strength evidence indicated that hospital-initiated support reduced length of stay for acute stroke, and low-strength evidence indicated that it reduced mortality for MI. Evidence was insufficient to determine the benefits and harms of the other types of transitional care interventions.

The authors acknowledged that few of the included studies were of high quality, that the usual care group was not often well defined, and that only six of the studies were done in the United States, among other limitations. However, they concluded that according to the available evidence, hospital-initiated transitional care can lead to improvements in certain outcomes for patients with acute stroke or MI. They called for more studies in this area, especially in U.S. settings.

“As the U.S. population ages and the number of patients who have MI or stroke increases, it is imperative to have transitional care interventions proven to be effective in improving functional outcomes, facilitating transfer of care from a hospital-based system to a community-based system, and preventing rehospitalization and adverse events,” the authors wrote.