Predictors of care transitions among dual-eligible residential care facility residents

Care transition through the acute, post-acute, and long-term care settings has remained a major challenge in improving quality of care and reducing costs in the Medicare and Medicaid populations. The objectives of this study were: to examine care transition patterns among residential care facility (RCF) residents in Florida and to identify predictors of burdensome transitions. We linked state Medicaid enrollment records, state vital records, Medicare and Medicaid claims data and identified 311 newly enrolled dual-eligible RCF residents in the state of Florida in 2003 who had at least one hospital or nursing home admission between 2003 and 2004. We defined transition as transfer among the following settings: RCF, hospital, and nursing home. We examined the association between baseline individual characteristics and the total number of transitions. We used Poisson regression model to examine predictors of total number of transitions and logistic regression model to estimate the effect of these predictors on the likelihood of having burdensome transitions. RCF residents had a mean age of 82 years and 77% were female. We found that 44% of residents had one transition, 28% had two transitions, and 28% had three or more transitions during the study period. We found that risk factors for transitions included: female, widowed, never married, more comorbid conditions, ADL, and IADL. On the other hand, older age, Black or Hispanic, and having caregiver were associated with fewer transitions. Future studies should investigate the impact of transitions on residents' quality of life and costs in this vulnerable population.