Variation in transitional care implementation patterns for older adults with stroke in Japan: A retrospective observational study.

Three distinct transitional care service implementation patterns were identified among Japanese acute care hospitals treating ischemic stroke patients.

• Latent Class Analysis of 4 binary domain indicators derived from 10 transitional care services was used to identify unobserved implementation patterns.
• Two patterns emphasized patient/family education and information transfer.
• The third pattern involved resource-intensive services, including discharge planning and structured coordination with post-discharge providers.
• The study population consisted of 14,129 patients aged ≥40 years admitted for ischemic stroke and discharged between April 2022 and August 2023.

Transitional care implementation patterns were significantly associated with hospital bed number and patient age.

• Conditional inference tree analysis incorporating hospital- and patient-level variables was applied to assess characteristics associated with each pattern.
• Both number of beds and patient age were significantly associated with pattern membership (all P < .01).
• Sensitivity analyses using fractional logit regression confirmed the number of beds as a consistent, significant factor across patterns.
• These associations held across all three identified implementation patterns.

Larger hospitals tended to implement more comprehensive combinations of transitional care services.

• Hospital size, as measured by number of beds, was the most consistent structural characteristic associated with transitional care implementation patterns.
• Sensitivity analyses using fractional logit regression were conducted to address uncertainty in pattern assignment and confirmed bed number as a significant factor.
• The findings suggest structural characteristic differences, particularly hospital size, likely explain variation in transitional care service delivery.

The study examined 10 transitional care services grouped into 4 domains using hospital-based claims data.

• Data were drawn from the Japan Medical Data Center hospital-based claims database.
• Transitional care services were identified from billing claims and grouped into 4 domains, which were converted into 4 binary indicators.
• The study sample included patients aged ≥40 years admitted for ischemic stroke and discharged from Japanese acute care hospitals between April 2022 and August 2023.
• Total sample size was 14,129 patients.

Transitional care service implementation patterns varied across Japanese acute care hospitals, reflecting structural differences between institutions.

• The retrospective observational study aimed to descriptively identify transitional care service implementation patterns and examine their associations with hospital-level characteristics.
• Variation in patterns was attributed to structural characteristic differences, particularly hospital size.
• The findings highlight how structural characteristics may contribute to variation in transitional care service delivery for older adults with stroke.