Disentangling organizational and economic levers in transitional care programs: A systematic review and configurational analysis

Background Promoting a safe and efficient transition of care is pivotal to reduce the readmission rate and related costs and improve the quality of patient care. A growing body of literature suggests that transitional care (TC) programs are effective in improving quality of life and reducing the number of unplanned readmissions for several groups of patients. TC programs are highly complex and multidimensional calling for new evidence on how specific practices influence their effectiveness in patient care and readmission reduction. Methods The study investigates, through a systematic review and a configurational approach, the roles played by system characteristics (size, ownership, professional skill, technology used), the components and the combination of components implemented, and the potential economic impact of transitional care programs. Results The more component are implemented, the higher the probability of a TC program successfully reducing readmission rates. Not all components have the same impact. The findings show that certain components are necessary: “Monitoring and Managing Symptoms after Discharge” and “Discharge Planning.” In settings where not all the components are feasible, the findings show two different combinations of component can achieve reduction in readmissions. Moreover, the study shows different ways to involve professionals’ skill mix and their mode of coordination in TC programs. Four organizational models emerge: the health-based monocentric, social-based monocentric, multidisciplinary team, and mono-specialist team. Conclusions The results underline the importance of examining in depth the role of organizational and economic factors in facilitating the creation of a successful TC program. The work gives preliminary insights into how to systematize management practices and different organization modes facilitating decision-makers’ choices in TC implementation.