Skip to main content

Advertisement

SpringerLink
Log in

Defining the characteristics of intermediate care models including transitional care: an international Delphi study

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions.

Aim

To identify and define the characteristics of intermediate care models.

Methods

A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted.

Results

Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models.

Discussion

There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination.

Conclusions

This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mansukhani RP, Bridgeman MB, Candelario D et al (2015) Exploring transitional care: evidence-based strategies for improving provider communication and reducing readmissions. P&T 40:690–694

    Google Scholar 

  2. Kripalani S, LeFevre F, Phillips CO et al (2007) Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 297:831–841

    CAS  Google Scholar 

  3. Lima M, Magalhaes AMM, Oelke ND et al (2018) Care transition strategies in Latin American countries: an integrative review. Rev Gaucha Enferm 39:e20180119

    Google Scholar 

  4. Coffey A, Leahy-Warren P, Savage E et al (2019) Interventions to promote early discharge and avoid inappropriate hospital (re)admission: a systematic review. Int J Environ Res Public Health 16:E2457

    Google Scholar 

  5. Forster AJ, Clark HD, Menard A et al (2004) Adverse events among medical patients after discharge from hospital. CMAJ 170:345–349

    Google Scholar 

  6. Baillie L, Gallini A, Corser R et al (2014) Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study. Int J Integr Care 14:e009

    Google Scholar 

  7. Allen J, Hutchinson AM, Brown R et al (2018) User experience and care for older people transitioning from hospital to home: patients' and carers' perspectives. Health Expect 21:518–527

    Google Scholar 

  8. Peel NM, Hubbard RE, Gray LC (2013) Impact of post-acute transition care for frail older people: a prospective study. J Frailty Aging 2:165–171

    CAS  Google Scholar 

  9. Loeffler K (2016) Geriatric intermediate care and transitional care for frailty-related patients: Kerstin Loeffler. Eur J Public Health 26:426–427

    Google Scholar 

  10. Allen J, Hutchinson AM, Brown R et al (2014) Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Serv Res 15:346

    Google Scholar 

  11. Lowthian J (2017) How do we optimise care transition of frail older people? Age Ageing 46:2–4

    Google Scholar 

  12. Inzitari M, Gual N, Roig T et al (2015) Geriatric screening tools to select older adults susceptible for direct transfer from the emergency department to subacute intermediate-care hospitalization. J Am Med Dir Assoc 16:837–841

    Google Scholar 

  13. World Health Organisation (2016) Transitions of care: technical series on safer primary care. Switzerland, Geneva

    Google Scholar 

  14. Coleman EA, Boult C (2003) Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc 51:556–557

    Google Scholar 

  15. Naylor MD (2006) Transitional care: a critical dimension of the home healthcare quality agenda. J Healthc Qual 28:48–54

    Google Scholar 

  16. Sezgin D, O'Caoimh R, Liew A et al (2019) Intermediate care interventions for older adults: ADVANTAGE joint action for frailty prevention work package 7 task group report. Madrid, p 1–48. https://advantageja.eu/images/WP7_Intermediate-and-transitional-care-task-group-report.pdf. Accessed 16 Apr 2020

  17. Beck AM, Kjaer S, Hansen BS et al (2013) Follow-up home visits with registered dieticians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial. Clin Rehabil 27:483–493

    Google Scholar 

  18. Cunliffe AL, Gladman JR, Husbands SL et al (2004) Sooner and healthier: a randomised controlled trial and interview study of an early discharge rehabilitation service for older people. Age Ageing 33:246–252

    Google Scholar 

  19. Mas MA, Inzitari M, Sabate S et al (2017) Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care. Age Ageing 46:925–931

    Google Scholar 

  20. Mas MÀ, Santaeugènia SJ, Tarazona-Santabalbina FJ et al (2018) Effectiveness of a hospital-at-home integrated care program as alternative resource for medical crises care in older adults with complex chronic conditions. J Am Med Dir Assoc 19:860–863

    Google Scholar 

  21. Wong FKY, Chau J, So C et al (2012) Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients. BMC Health Serv Res 12:1–8

    Google Scholar 

  22. Kind AJ, Brenny-Fitzpatrick M, Leahy-Gross K et al (2016) Harnessing protocolized adaptation in dissemination: successful implementation and sustainment of the veterans affairs coordinated-transitional care program in a non-veterans affairs hospital. J Am Geriatr Soc 64:409–416

    Google Scholar 

  23. Xiang X, Zuverink A, Rosenberg W et al (2019) Social work-based transitional care intervention for super utilizers of medical care: a retrospective analysis of the bridge model for super utilizers. Soc Work Health Care 58:126–141

    Google Scholar 

  24. Galbraith AA, Meyers DJ, Ross-Degnan D et al (2017) Long-term impact of a postdischarge community health worker intervention on health care costs in a safety-net system. Health Serv Res 52:2061–2078

    Google Scholar 

  25. Shah MN, Hollander MM, Jones CM et al (2018) Improving the ED-to-home transition: the community paramedic-delivered care transitions intervention-preliminary findings. J Am Geriatr Soc 66:2213–2220

    Google Scholar 

  26. Naylor MD, Bowles KH, McCauley KM et al (2013) High-value transitional care: translation of research into practice. J Eval Clin Pract 19:727–733

    Google Scholar 

  27. Manville M, Klein M, Bainbridge L (2014) Improved outcomes for elderly patients who received care on a transitional care unit. Can Fam Phys 60:e263–e271

    Google Scholar 

  28. Blewett LA, Johnson K, McCarthy T et al (2010) Improving geriatric transitional care through inter-professional care teams. J Eval Clin Pract 16:57–63

    Google Scholar 

  29. Caplan GA, Coconis J, Board N et al (2006) Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial). Age Ageing 35:53–60

    Google Scholar 

  30. Goodwin JS, Li S, Middleton A et al (2018) Differences between skilled nursing facilities in risk of subsequent long-term care placement. J Am Geriatr Soc 66:1880–1886

    Google Scholar 

  31. Herfjord JK, Heggestad T, Ersland H et al (2014) Intermediate care in nursing home after hospital admission: a randomized controlled trial with one year follow-up. BMC Res Notes 9:889

    Google Scholar 

  32. Melis RJF, Rikkert MGMO, Parker SG et al (2004) What is intermediate care? BMJ 329:360–361

    Google Scholar 

  33. Martin GP, Peet SM, Hewitt GJ et al (2004) Diversity in intermediate care. Health Soc Care Commun 12:150–154

    Google Scholar 

  34. Colquhoun HL, Levac D, O'Brien KK et al (2014) Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol 67:1291–1294

    Google Scholar 

  35. Levac D, Colquhoun H, O'Brien KK (2010) Scoping studies: advancing the methodology. Implement Sci 5:69

    Google Scholar 

  36. Tricco AC, Lillie E, Zarin W et al (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473

    Google Scholar 

  37. Lockwood C, Munn Z, Porritt K (2015) Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc 13:179–187

    Google Scholar 

  38. Hanafin S (2004) Review of literature on the Delphi Technique. In: Affairs DoCaY (ed) Ireland: National Children's Office, p. 1–54

  39. Linstone HA, Turoff M (2002) The Delphi method techniques and applications. Newark. https://web.njit.edu/~turoff/pubs/delphibook/delphibook.pdf. Accessed 16 Apr 2020

  40. Giannarou L, Zervas E (2014) Using Delphi technique to build consensus in practice. Int J Bus Sci Appl Manag 9:65–82

    Google Scholar 

  41. Hendry A, Vanhecke E, Carriazo AM et al (2019) Integrated care models for managing and preventing frailty: a systematic review for the European Joint Action on Frailty Prevention (ADVANTAGE JA). Transl Med UniSa 19:5–10

    CAS  Google Scholar 

  42. Hsu CC, Sandford BA (2007) The Delphi technique: making sense of consensus. Pract Assess Res Eval 12:1–8

    Google Scholar 

  43. Diamond IR, Grant RC, Feldman BM et al (2014) Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 67:401–409

    Google Scholar 

  44. Steiner A (1997) Intermediate care: a conceptual framework and review of the literature. King's Fund, London

    Google Scholar 

  45. Griffiths PD, Edwards MH, Forbes A et al (2007) Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Syst Rev 2:CD002214

    Google Scholar 

  46. Kansagara D, Chiovaro JC, Kagen D et al (2016) So many options, where do we start? An overview of the care transitions literature. J Hosp Med 11:221–230

    Google Scholar 

  47. Shahsavari H, Zarei M, Aliheydari MJ (2019) Transitional care: concept analysis using Rodgers' evolutionary approach. Int J Nurs Stud 99:103387

    Google Scholar 

  48. Jeffs L, Saragosa M, Law MP et al (2017) The role of caregivers in interfacility care transitions: a qualitative study. Patient Prefer Adher 11:1443–1450

    Google Scholar 

  49. Weerahandi H et al (2015) Effects of a psychosocial transitional care model on hospitalizations and cost of care for high utilizers. Soc Work Health Care 54:485–498

    Google Scholar 

  50. Rosbach M, Andersen JS (2017) Patient-experienced burden of treatment in patients with multimorbidity—a systematic review of qualitative data. PLoS ONE 12:e0179916

    Google Scholar 

  51. Hasardzhiev S, Mendao L, Nolte W et al (2016) Managing multimorbidity: how can the patient experience be improved? J Comorb 6:28–32

    Google Scholar 

  52. Gibson MJ, Kelly KA, Kaplan AK (2012) Family caregiving and transitional care: a critical review. In: U.S. Department of Health and Human Services AfCL, Administration on Aging (ed) The National Center on Caregiving, Family Caregiver Alliance, USA, p. 1–54

  53. Willis G, Edwards M, Lyscom T, et al (2015) Future demand for skills: initial results. In: Health Do (ed) The Centre for Workforce Intelligence (CfWI), United Kingdom, p. 13

  54. Manias E, Bucknall T, Hughes C et al (2019) Family involvement in managing medications of older patients across transitions of care: a systematic review. BMC Geriatr 19:95

    Google Scholar 

  55. Kansagara D, Chiovaro JC, Kagen D, et al (2015) Transitions of care from hospital to home: an overview of systematic reviews and recommendations for improving transitional care in the veterans health administration. In: Service DoVAHSRD (ed) Quality Enhancement Research Initiative, Washington, p. 1-62

  56. Feuerwerker LCM, Merhy EE (2008) A contribuição da atenção domiciliar para a configuração de redes substitutivas de saúde: desinstitucionalização e transformação de práticas. Rev Panam Salud Publica 24:180–188

    Google Scholar 

  57. World Health Organisation (2018) Continuity and coordination of care: A practice brief to support implementation of the WHO Framework on integrated people-centred health services. World Health Organisation, Geneva

    Google Scholar 

Download references

Funding

This paper is part of Joint Action ‘724099/ADVANTAGE’ which has received funding from the European Union’s Health Programme (2014–2020).

Author information

Authors and Affiliations

  1. College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway City, Ireland

    Duygu Sezgin

  2. Department of Geriatric Medicine, Mercy University Hospital Cork, Cork City, Ireland

    Rónán O’Caoimh

  3. Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland

    Mark R. O’Donovan

  4. St Vincent De Paule LTC Facility, Marsa, Malta

    Mohamed A. Salem

  5. Older Person’s Programme, Health Service Executive, Dublin, Ireland

    Siobhán Kennelly

  6. Andalusian Public Foundation of Progress and Health (FPS), Seville, Spain

    Luz Lopez Samaniego & Rafael Rodriguez-Acuña

  7. Hospital a Domicili Integral Geriatria (HaDo), Barcelona, Spain

    Cristina Arnal Carda

  8. Parc Sanitari Pere Virgili, Vall D’Hebrón Institute of Research (VHIR), and Universitat Autònoma de Barcelona, Barcelona, Spain

    Marco Inzitari

  9. Finnish Institute for Health and Welfare (THL), Helsinki, Finland

    Teija Hammar

  10. NHS Benchmarking Network, Manchester, England

    Claire Holditch

  11. Duke University, Durham, USA

    Janet Prvu Bettger

  12. NHS England, London, England

    Martin Vernon

  13. Manchester University NHS Foundation Trust, London, England

    Martin Vernon

  14. University College Dublin, Dublin, Ireland

    Áine Carroll

  15. National Rehabilitation Hospital, Dún Laoghaire, County Dublin, Ireland

    Áine Carroll

  16. University of Plymouth, Plymouth, England

    Felix Gradinger

  17. Torbay and South Devon NHS Foundation Trust, Torbay, England

    Felix Gradinger

  18. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Gaston Perman

  19. Raigmore Hospital Inverness NHS Highland, Inverness, Scotland

    Martin Wilson

  20. Department of Geriatric Medicine, University of Malta, Msida, Malta

    Antoine Vella

  21. Geriatria, Accettazione geriatrica e Centro di Ricerca Per L’invecchiamento, IRCCS INRCA, Ancona, Italy

    Antonio Cherubini

  22. Community Hospitals Association (UK), University of Winchester, Winchester, England

    Helen Tucker

  23. Post-Graduate Medical School in Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy

    Maria Pia Fantini

  24. Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy

    Graziano Onder

  25. Department of Internal Medicine, Medical University of Graz, Graz, Austria

    Regina Roller-Wirnsberger

  26. National Institute of Geriatric Medicine at the National Institutes of Health, Mexico City, Mexico

    Luis Miguel Gutiérrez-Robledo

  27. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università Degli Studi di Milano, Milan, Italy

    Matteo Cesari

  28. Alves Pereira, Public Health School, University of São Paulo (FSP/USP), São Paulo, Brazil

    Paula Bertoluci

  29. Center for Innovation and Technology Transfer, Medical University of Lodz, Lodz, Poland

    Magdalena Kieliszek

  30. HU University of Applied Sciences, Utrecht, The Netherlands

    Wilma van der Vlegel-Brouwer

  31. Lunenfeld-Tanenbaum Research Institute, Toronto, Canada

    Michelle Nelson

  32. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Michelle Nelson

  33. Jefe de Servicio de Geriatría Hospital Universitario de Getafe, Getafe, Spain

    Leocadio Rodríguez Mañas

  34. Rehabilitation Clinic Patras University Hospital, Patras, Greece

    Eleftheria Antoniadou

  35. Pilote MAIA 13 Projets Parcours Pays Salonais, Pays Salonais, France

    François Barriere

  36. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

    Sebastian Lindblom

  37. Fraser Health Authority, British Columbia, Canada

    Grace Park

  38. Regional Ministry of Health and Families of Andalusia (CSFJA), Seville, Spain

    Isidoro Pérez

  39. Andalusian Health Service (Servicio Andaluz de Salud, SAS), Seville, Spain

    Dolores Alguacil

  40. NHS Scotland, Edinburgh, Scotland

    Douglas Lowdon

  41. Bidasoa Integrated Healthcare Organisation, Osakidetza, Basque Country, Spain

    Maria Eugenia Alkiza

  42. The Spanish Society of Geriatrics Medicine (SEMEG), Madrid, Spain

    Cristina Alonso Bouzon

  43. University of Leeds, Leeds, England

    John Young

  44. Regional Ministry of Health and Families of Andalusia (CSFJA), Seville, Spain

    Ana Carriazo

  45. Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland

    Aaron Liew

  46. Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland

    Aaron Liew

  47. NHS Lanarkshire, Glasgow, Scotland

    Anne Hendry

  48. University of the West of Scotland, Glasgow, Scotland

    Anne Hendry

Authors
  1. Duygu Sezgin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rónán O’Caoimh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark R. O’Donovan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed A. Salem
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Siobhán Kennelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luz Lopez Samaniego
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cristina Arnal Carda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rafael Rodriguez-Acuña
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marco Inzitari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Teija Hammar
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Claire Holditch
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Janet Prvu Bettger
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Martin Vernon
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Áine Carroll
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Felix Gradinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Gaston Perman
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Martin Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Antoine Vella
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Antonio Cherubini
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Helen Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Maria Pia Fantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Graziano Onder
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Regina Roller-Wirnsberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Luis Miguel Gutiérrez-Robledo
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Matteo Cesari
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Paula Bertoluci
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Magdalena Kieliszek
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Wilma van der Vlegel-Brouwer
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Michelle Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Leocadio Rodríguez Mañas
    View author publications

    You can also search for this author in PubMed Google Scholar

  31. Eleftheria Antoniadou
    View author publications

    You can also search for this author in PubMed Google Scholar

  32. François Barriere
    View author publications

    You can also search for this author in PubMed Google Scholar

  33. Sebastian Lindblom
    View author publications

    You can also search for this author in PubMed Google Scholar

  34. Grace Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  35. Isidoro Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  36. Dolores Alguacil
    View author publications

    You can also search for this author in PubMed Google Scholar

  37. Douglas Lowdon
    View author publications

    You can also search for this author in PubMed Google Scholar

  38. Maria Eugenia Alkiza
    View author publications

    You can also search for this author in PubMed Google Scholar

  39. Cristina Alonso Bouzon
    View author publications

    You can also search for this author in PubMed Google Scholar

  40. John Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  41. Ana Carriazo
    View author publications

    You can also search for this author in PubMed Google Scholar

  42. Aaron Liew
    View author publications

    You can also search for this author in PubMed Google Scholar

  43. Anne Hendry
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

European Union Advantage Joint Action Work Package 7 partners in collaboration with the International Foundation for Integrated Care Special Interest Group on Intermediate Care

Corresponding author

Correspondence to Rónán O’Caoimh.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Disclaimer

The content of this report represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.

Statement of human and animal rights

All procedures performed in this study complied with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

All participants provided informed written (electronic) consent in advance of the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rónán O’Caoimh, Aaron Liew and Anne Hendry are co-senior authors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 59 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sezgin, D., O’Caoimh, R., O’Donovan, M.R. et al. Defining the characteristics of intermediate care models including transitional care: an international Delphi study. Aging Clin Exp Res 32, 2399–2410 (2020). https://doi.org/10.1007/s40520-020-01579-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-020-01579-z

Keywords

Search

Navigation