Residential and health care transition patterns among older medicare beneficiaries over time

Purpose: To describe annual care transition patterns across residential and health care settings and assess consistency in care transition patterns across years. Design and Methods: This retrospective cohort study used the Medicare Current Beneficiary Survey (2000-2005). The sample comprised beneficiaries aged 65 years and older (N = 57,684 person-years of observation). We defined annual care transition patterns by combining 4 types of settings: C (community), F (facility), S (skilled nursing facility - SNF), and H (hospital). We compared weighted frequencies of transition patterns across years. We counted repeated/multiple transitions that involved movement into hospital and SNF settings and compared them by demographic characteristics. Results: Care transition patterns remained consistent from year to year. Approximately 22% of the study population experienced a transition annually. The most frequent transition pattern was transition to the hospital and back. Care transition patterns were enormously heterogeneous with more than 230 unique patterns; approximately 1 in 4 community-dwelling (∼23%) and most facility-dwelling (∼60%) beneficiaries with at least one transition had a unique transition pattern. Beneficiaries residing in a facility were more likely to undergo multiple transitions to hospitals and SNFs compared with community-dwelling beneficiaries. Implications: The study provides a description of annual care transition patterns across six years. Knowledge of the consistency of care transition patterns may serve as a baseline from which to compare future patterns and aid in designing interventions targeted at specific transitions.