Self-management Knowledge and Skills of Geriatric Patients in Care Transitions

Higher cost of geriatric patient readmissions in acute care settings has prompted hospitals to initiate transitional care programs that focus on cost-saving measures and quality of patient care. Transitional care interventions that improve patients' self-care management skills can promote better patient outcomes and reduce avoidable readmissions. This pilot study utilized mail-in surveys to examine differences in the self-management knowledge and skills between geriatric patients who received care transition interventions and those who did not during their hospital stays. Coleman's Care Transition Measurement-15 (CTM-15RTM) survey tool was used to measure study participants' reported self-management skills after their discharges from a tertiary hospital. Data collected from 27 participants (response rate=36.8%) were analyzed using the SAS software (version 9.3). In comparing gender and living status, there were no differences between the two groups. Furthermore, there were no differences found in domains 1, 2, and 4 that tested self-management skills in stages of during and after the hospital stays between the two groups. However, there was a statistically significant difference in participants' caregiver status (p=0.046) and potentially a difference in domain 3 that tested the patients' understanding of follow-up doctor's/laboratory appointments (p=0.090) between the two groups. A major limitation of this pilot study was the small sample size. Future studies are needed to identify influencing factors that may affect patients' self-management skills and abilities during care transitions.