The convergence of rising post-acute health care costs with incomparable outcomes have
made reform a priority resulting in the development of new models of care that often extend the scope of practice and
job duties among health professionals. In these new models, aimed to improve clinical and cost effectiveness of care,
advance practice “transitionists” diagnose, triage, conservatively treat, and help patients navigate safe return to
community. However, little is known about the effects of such models on post-acute outcomes. The purpose of this
study was to evaluate the effectiveness of an advanced practice model of care in a transitional care unit (AP-TCU) on
post-acute outcomes compared to standard care in skilled nursing facilities (SNF).
Methods:
Secondary analysis of clinical and administrative data extracted from Electronic Medical
Records (EMR) of patients (N =2880) admitted in the state of Georgia to an AP-TCU (n =1440) compared to SNFs (n
=1440) between January 2014 and December 2015. SNF to AP-TCU cases were randomly control-matched by payer
(Medicare and Managed Care) and most prevalent medical diagnostic groups (orthopedics, neurological, pulmonary,
and cardiac). Outcome variables included length of stay (LOS), functional gain, discharge level, discharge destination,
re-hospitalization rate and patient experience. To compare group differences, independent t -test was used for LOS,
functional gain, re-hospitalization rate while the non-parametric equivalent was used for discharge disposition. Likertscale
survey based on phenomenological methods was used to measure as an overall factor of patient experience.
Patient experience, defined as satisfaction with quality of care and overall satisfaction, was factored from nursing,
rehabilitation, dining, and privacy-security indices.
Results:
Significant differences were observed between AP-TCU and SNF in mean LOS (19.0 vs 27.3, p = <.001),
functional gain (1.1 vs 0.9, p = <.001), discharge level (2.1 vs 1.7, p = <.001), re-hospitalization rate (7.8% vs 14.3%, p
= .02). Significant differences were also observed among AP-TCU and SNFs in discharge to the community (82.7%
vs 45.1, p = <.001) and patient experience (96% vs 72, p = .04).
Conclusions:
These results provide evidence supporting the clinical effectiveness of an AP-TCU model of
care for adults recovering from surgeries, trauma, acute exacerbations of chronic illnesses. Compared to SNFs,
patients receiving care within an AP-TCU model achieve better post-acute outcomes, greater functional recovery in
less time, with a higher percentage of patients satisfied with overall experience and quality of care. Future studies
should include EMR data from other post-acute practices such as inpatient rehabilitation facilities as well as claims
data to compare cost effectiveness across different settings.