Implementation of Transitional Care for Medicare Patients to Improve the Quality of Care

Importance: Transitional care for elderly patients who suffer from multiple chronic medical conditions is essential to reduce the length of and improve the quality of care. According to the 2010 census, older adults accounted for 13 % of the United States population. There were 58 million Medicare enrollees with approximately $ 135 billion in expenditures for Medicare beneficiaries’ inpatient hospital costs in 2017. The average length of stay (LOS) in the acute care setting for ages 65 to 84 was 5.2 days with a mean cost of $ 11,300 per stay nationwide in 2016.

Methodology: The study was designed as a descriptive statistic through a retrospective chart review in a teaching hospital in northern New Jersey. The study sample of 102 charts randomly selected. The study sample consisted of Medicare patients 65 years and older who were diagnosed with sepsis which includes severe sepsis and septic shock ranging from the beginning of the third quarter of 2018 to the end of the second quarter in 2019.

Analysis: The variables of the study were age, gender, ethnicity, number of chronic medical conditions, mortality, diagnosis, 30-day readmission, patient’s support system in the community, transitional care, and discharged to. This study used descriptive statistics and a Kruskal-Wallis or Wilcoxon-Rank Sum test to assess the differences in LOS.

Results: There were 57 females (55.9%) and 45 males (44.1%) in the study. 50.0% of cases were 79 years and older. Sepsis were 44 cases (43.1%), severe sepsis 44 cases (43.1%), and septic shock 18 cases (17.6%). The majority of ethnicity was white with 65 cases (63%), followed by black or African-American (22.5%). 27 (24.9 %) out of 81 cases (excluded 21 deaths as an inpatient from the total 102 cases) were readmitted within 30 days after discharge. 24 (23.5 %) cases had 5 chronic medical conditions, followed by 23 (22.5%) of cases who had 4 chronic medical conditions. 99% (101 cases) had a community support system, and 3 cases (2.9 %) had transitional care APN involvement during the hospitalization. The mortality of this sample population was 20.6% (21 cases), 24.5% (25 cases) discharged to skilled nursing facilities, 17.6% (18 cases) to home with visiting nurse services, and 17.6% (18 cases) to home with family care. The mean LOS for sepsis was 9.2, severe sepsis 9.8, and septic shock 19.4. This study did not find a statistically significant factor that impacted LOS. Yet, the p-value of age was 0.149 followed by the p-value of 0.163 for comorbidity.