Inadequate Financing in Long-Term Transition Care Essay

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Author, Year of PublicationPurposeSampleDesignLevel of EvidenceFindingsLimitations
Gruneir et al. (2012)To describe ways of reducing hospital readmissions through financial incentivesAll chronic long term care patients
(N=64,589 residents)
Retrospective cohort study employing linked data from Ontario, CanadaVI: evidence from a single qualitative
6-month cumulative study
Older chronic LTC patients experience an ED transfers which eventually translates to higher medical costs. Transitional care requires more focusLack of comparative data group or random
A very narrow time difference between admission and readmission. This could not permit proper assessment.
Jackson, Trygstad, DeWalt & DuBard (2013)To investigate how to reduce hospitalization for long-term care through a local targeted careA convenient sample of Transitional care patients
(N = 13,476)
While those under usual care was
Usual care
(N = 7,899
intent-to-treat
model
Patients classified by disease burden via the design of categorical and hierarchical Clinical Risk Group
VI: evidence from two quantitative and independent studiesRecurrent hospitalization is a major financial burden to American patients receiving long-term transition care. Transitional care also reduces the possibility of hospital readmissionResults were affected by selection bias due to observations made. Prevalence of endogeneity issues.
De Rooij et al. (2012)To offer insight into family caregivers in relation to the cost of long term careConventional and small-scale settings (n = 179)A quasi-experimental longitudinal design.VI: conventional evidence compared in multiple empirical studiesProfessional caregivers can be reached easily by caregivers who reside in small-scale settings. This minimizes the cost of managing long-term medical conditions such as dementiaPossibility of misleading answers from participants.
Poor capturing of data in large scale settings
Wong, Chau, So, Tam & McGhee (2012)To assess the cost-effectiveness of transitional care programsSuitable sample of patients (N=555)A descriptive study of patients who met specific inclusion criteria such as age, disease burdenVI: evidence from a single empirical study on the transitional care programIn controlled groups, the readmission rates were higher and hence the cost of funding long-term care also went up considerably. There was no significant difference in terms of utility values between the two groups namely the study and controlled groups.Nonmedical costs were not included in the study. Hence, medical costs were underestimated. The study included hospitalization expenses only.

Summary

The research paper addressed the following question: How do healthcare institutions cope with the challenge of inadequate funding in long-term transitional care? Apart from the sample used in the Gruneir et al (2012) research paper, all the other samples were just convenient sizes arbitrarily selected to carry out the research. Hence, it can be argued out that the three research studies present results that are largely estimates of the study outcomes. In order to obtain the required and relevant research articles, the search process entailed the use of keywords in targeted databases such as Ebscohost and Proquest. Thereafter, the results were streamlined to peer-reviewed journals that were no older than the year 2010. Finally, the obtained peer-reviewed journal articles were manually checked if they met the required standards of the assignment.

In regards to the design used in the studies, it is vital to mention that the first study by Gruneir et al (2012) employed a retrospective cohort study whereby the research components were compared to similar past studies. An intent-to-treat model was used as a research study design in the journal article by Jackson, Trygstad, DeWalt, and DuBard (2013). On the other hand, a descriptive research design was used in the study by Wong, Chau, So, Tam and McGhee (2012). However, De Rooij et al (2012) employed a quasi-experimental longitudinal design in the methodology section. This was a quasi-experimental research study bearing in mind that it did not possess randomization and vivid results. There is no single research study that belongs to the top level of evidence. However, a quasi-experimental study is considered to bear more evidence than a descriptive study. All the above studies concur that long-term transition care is a costly undertaking that requires adequate funding in order to reduce the disease burden. According to the research study by Gruneir et al (2012), clinical readmissions are major impediments to the successful reduction of medical bills.

On a general note, these studies concur that the financial burden of long-term transition care affects numerous healthcare domains such as staffing, quality delivery of care services to patients, research and development in hospital settings as well as poor career growth among medical professionals.

The studies also answer the research question even though the conclusive findings given in some of the research journals are not clear. For instance, a study by Jackson, Trygstad, DeWalt and DuBard (2013) does not clearly state the magnitude of impacts of financial burden among patients undergoing long-term transition care. While the medical challenges are evident, there is a need to categorically highlight how patients often struggle to meet the costs of sustaining them in nursing homes.

As already hinted, several limitations are visible in the above studies. These include bias during experimental phases of the research studies, missing nonmedical costs in the analysis, and prevalence of endogeneity issues. Additional experimental studies are required to supplement the current findings. There is a need for clear, objective transitional care outcomes with both dependent and independent variables.

References

De Rooij, A. H., Luijkx, K. G., Spruytte, N., Emmerink, P. M., Schols, J. M., & Declercq, A. G. (2012). Family caregiver perspectives on social relations of elderly residents with dementia in small-scale versus traditional long-term care settings in the Netherlands and Belgium. Journal of Clinical Nursing, 21(21/22), 3106- 3116.

Gruneir, A., Bronskill, S., Bell, C., Gill, S., Schull, M., Ma, X., & Rochon, P. A. (2012). Recent health care transitions and emergency department use by chronic long term care residents: A population-based cohort study. Journal of the American Medical Directors Association, 13(3), 202-206.

Jackson, C. T., Trygstad, T. K., DeWalt, D. A., & DuBard, C. A. (2013). Transitional care cut hospital readmissions for north Carolina medicaid patients with complex chronic conditions. Health Affairs, 32(8), 1407-1415.

Wong, F. K. Y., Chau, J., So, C., Tam, S. K. F., & McGhee, S. (2012). Cost- effectiveness of a health-social partnership transitional program for post- discharge medical patients. BMC Health Services Research, 12, 479-489.

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