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Hi Joanne and all Our realist review (2013) of intermediate care (i.e. early supported discharge and admission avoidance - in my understanding, 'care transitions' by another name) could provide a useful starting point. The review drew on international sources, with conclusions framed in terms of implications for the UK - and contains summaries at the levels of organisations, professionals, and service users. You can access the review here: http://www.nets.nihr.ac.uk/__data/assets/pdf_file/0017/85121/FR-10-1012-07.pdf (Exec summary p10-14; Summaries p72 and p77; Conclusion p102-108) As intermediate care is such a broad area, the review focused on older people (age >65y), and people with stroke, CHD, COPD, and cognitive impairment. However, we still have a database, coded by 'type' (e.g. for paediatrics, surgical interventions, and so on) which is just waiting to find a good (funded) home. Possibly lots to discuss? Best wishes Mark Mark Pearson PhD Senior Research Fellow Peninsula Technology Assessment Group (PenTAG) University of Exeter Medical School E: [log in to unmask] T: 0044 (0) 1392 726079 http://medicine.exeter.ac.uk/about/profiles/index.php?web_id=Mark_Pearson ________________________________________ From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [[log in to unmask]] on behalf of Joanne Lynn [[log in to unmask]] Sent: 10 February 2014 16:04 To: [log in to unmask] Subject: Re: Care Transitions and the PCORI RFP in the US One would want to know the answers to that question, and indeed to become quite good at all its ramifications, but the question that the policymakers want is a next step - given that we want to drive down that rate (a controversial claim for sure), what works, where, when, and how, and therefore what improvements should be priorities for system managers to pursue (in what settings, for what populations) in the future? To be fair, the PCORI announcement actually asks for improvements in care transitions, which is not the same as short-term readmissions - and allows the bidder to improve our tools for measuring transitions from the patient/family perspective. So - the policy question might well be something like "What improvements should be priorities for system managers to implement (in what settings, for what populations) in order to improve care transitions from the patient/family perspective?" -----Original Message----- From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Geoff Wong Sent: Monday, February 10, 2014 3:48 AM To: [log in to unmask] Subject: Re: Care Transitions and the PCORI RFP in the US As another starting point, we could develop an appropriate realist research question. Here is an initial question which I am sure could do with refining. "Who re-presents back to hospital within 30 days of discharge, how, why and in what circumstances?" From this I can see that a programme theory might follow? Geoff