Journal of General Internal Medicine

, Volume 34, Issue 11, pp 2497–2504 | Cite as

The Care Transitions Measure-3 Is Only Weakly Associated with Post-discharge Outcomes: a Retrospective Cohort Study in 48,384 Albertans

  • Finlay A. McAlisterEmail author
  • Mu Lin
  • Jeff Bakal
  • Kyle A. Kemp
  • Hude Quan
Original Research



The National Quality Forum endorsed a 3-item Care Transitions Measure (CTM-3), part of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, for evaluating hospital care transitions performance.


To explore whether CTM-3 scores are a suitable proxy for quality of transitional care.


Retrospective cohort study.


A random sample of 48,384 adults discharged from medical or surgical wards in all 113 acute care hospitals in Alberta, Canada, between April 2011 and March 2016.

Main Measures

CTM-3 scores and their associations with all-cause emergency department (ED) visits or non-elective readmissions at 30 days, 3 months, and 12 months anywhere in the province.


CTM-3 scores were significantly lower (all p < 0.01) for females, older patients, those discharged from medical wards or teaching hospitals, and those with longer length of stay, higher Charlson scores, prior ED visits/hospitalizations, or who did not return to independent living after discharge. CTM-3 scores were not significantly associated with outcomes at 30 days (mean score 77.5 in those who subsequently had an ED visit/readmission vs. 77.9 in those who did not, p = 0.13, aOR 0.99, 95% CI 0.99–0.99). Although CTM-3 scores were significantly lower in patients who subsequently had ED visit/readmission at 3 months (77.5 vs. 78.5) and 12 months (77.6 vs. 79.5), the magnitude of risk was small: for every 10 point decrease in the CTM-3 score, the risk of ED visit/readmission was 2.6% higher (aOR 1.03, 95% CI 1.01–1.05) at 3 months and 4.0% higher (aOR 1.04, 95% CI 1.01–1.08) at 12 months.


The CTM-3 score is influenced by baseline patient and hospital factors, is not associated with 30-day post-discharge outcomes, and is only weakly associated with 3- and 12-month outcomes. These findings suggest that the CTM-3 score is not a good performance measure for the quality of transitional care.


transitions of care quality patient experience of care questionnaires readmissions Hospital Consumer Assessment of Healthcare Providers and Systems survey 


Authors’ Contributions

Study concept and design: FM, KK, HQ.

Acquisition of data: FM, ML, JB.

Statistical analysis: ML, JB.

Interpretation of data and first draft of manuscript: FM.

Critical revisions of manuscript and approval of submission: all authors.


No project-specific funding. FM holds the Alberta Health Services Chair in Cardiovascular Outcomes at the University of Alberta.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5260_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Finlay A. McAlister
    • 1
    • 2
    Email author
  • Mu Lin
    • 2
  • Jeff Bakal
    • 2
  • Kyle A. Kemp
    • 3
  • Hude Quan
    • 3
  1. 1.Division of General Internal Medicine University of AlbertaEdmontonCanada
  2. 2.Data Platform, Alberta Strategy for Patient Oriented Research Support UnitAlberta InnovatesEdmontonCanada
  3. 3.Department of Community Health Sciences, O’Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada

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