Transitional care clinics for patients discharged from hospital without a primary care provider: A systematic review

Cait Dmitriew; Del J Houle; Michelle Filipovic; Ella Chochla; Alexander Hemy; Celeste Woods; Nawal Farhat; Alanna Campbell; Lisa J W Liu; Jacquelyn J Cragg; James A G Crispo

doi:10.1002/jhm.13359

Transitional care clinics for patients discharged from hospital without a primary care provider: A systematic review

J Hosp Med. 2024 Apr 16. doi: 10.1002/jhm.13359. Online ahead of print.

Authors

Cait Dmitriew¹, Del J Houle², Michelle Filipovic³, Ella Chochla³, Alexander Hemy⁴, Celeste Woods⁵, Nawal Farhat^{6

7}, Alanna Campbell^{8

9}, Lisa J W Liu^{10

11}, Jacquelyn J Cragg^{10

11}, James A G Crispo^{7

9

10

11}

Affiliations

¹ Department of Family Medicine, NOSM University, Sudbury, ON, Canada.
² Undergraduate Medical Education Program, NOSM University, Sudbury, ON, Canada.
³ Department of Family Medicine, NOSM University, Sault Ste. Marie, ON, Canada.
⁴ Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁵ Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ School of Mathematics and Statistics, Carleton University, Ottawa, ON, Canada.
⁷ TruEffect Inc., Sudbury, ON, Canada.
⁸ Health Sciences Library, NOSM University, Sudbury, ON, Canada.
⁹ Human Sciences Division, NOSM University, Sudbury, ON, Canada.
¹⁰ Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
¹¹ International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.

PMID: 38623808
DOI: 10.1002/jhm.13359

Abstract

Background: The transition from hospital to home is a high-risk period. Timely follow-up care is essential to reducing avoidable harms such as adverse drug events, yet may be unattainable for patients who lack attachment to a primary care provider. Transitional care clinics (TCCs) have been proposed as a measure to improve health outcomes for patients discharged from hospital without an established provider. In this systematic review, we compared outcomes for unattached patients seen in TCCs after hospital discharge relative to care as usual.

Methods: We searched the following bibliographic databases for articles published on or before August 12, 2022: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PsycINFO, and Web of Science. Five studies were identified that examined the effects of a dedicated postdischarge clinic on emergency department (ED) visits, readmissions, and/or mortality within 90 days of discharge for patients with no attachment to a primary care provider.

Results: Studies were heterogeneous in design and quality; all were from urban centers within the United States. Four of the five studies reported a reduction in either the number of ED visits or readmissions in patients seen in a TCC following hospitalization.

Conclusions: TCCs may be effective in reducing hospital contacts in the period following hospital discharge in patients with no established primary care provider. Further studies are required to evaluate the health benefits attributable to the implementation of TCCs across a broad range of practice contexts, as well as the cost implications of this model.

Publication types

Review