Trial reportJournal of the American Geriatrics Society2017
Connect-Home: Transitional Care of Skilled Nursing Facility Patients and their Caregivers.
Trial report in Journal of the American Geriatrics Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- Roles and functions of social workers in long-term care for older adults in East and North-East Asia: a mixed-methods systematic review since 2000.Frontiers in public health · 2026Pooled it
- Interventions for the empowerment of older people and informal caregivers in transitional care decision-making: short report of a systematic review.BMC geriatrics · 2023Pooled it
- Preparedness for care transitions to home and acute care use of skilled nursing facility patients.BMC geriatrics · 2025Trial
- Health Trajectories of Skilled Nursing Facility Patients With Alzheimer's Disease and Related Dementias: Evidence for Practicing Nurses.Journal of gerontological nursing · 2024Trial
- Connect-Home transitional care from skilled nursing facilities to home: A stepped wedge, cluster randomized trial.Journal of the American Geriatrics Society · 2023Trial
- A streamlined approach to classifying and tailoring implementation strategies: recommendations to speed the translation of research to practice.Implementation science communications · 2024Article
- Unique Care Needs of People with Dementia and Their Caregivers during Transitions from Skilled Nursing Facilities to Home and Assisted Living: A Qualitative Study.Journal of the American Medical Directors Association · 2022Article
- Where Skilled Nursing Facility Residents Get Acute Care: Is the Emergency Department the Medical Home?Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2021Article
- 'Bare-bones' to 'silver linings': lessons on integrating a palliative approach to care in long-term care in Western Canada.BMC health services research · 2021Article
- Complex Transitions from Skilled Nursing Facility to Home: Patient and Caregiver Perspectives.Journal of general internal medicine · 2021Article
- Article
- Implementing a Standardized Transition Care Plan in Skilled Nursing Facilities.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2020Article
- Practicality of Acute and Transitional Care and its consequences in the era of SwissDRG: a focus group study.BMC health services research · 2019Article
- Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study.Journal of the American Medical Directors Association · 2019Article
- The Association Between Chronic Condition Symptoms and Treatment Burden in a Skilled Nursing Population.Journal of gerontological nursing · 2018Article
- Evaluating the impact of a home-based rehabilitation service on older people and their caregivers: a matched-control quasi-experimental study.Clinical interventions in aging · 2018Article
- Improving Suicide Risk Detection and Clinical Follow-up after Discharge from Nursing Homes.Clinical gerontologistArticle
- Engaging national and regional partners to accelerate broad-scale implementation of nurse-developed interventions.Nursing outlookArticle
- Examining transitional care for patients and caregivers: Lessons from a Brazilian public university hospital.Clinics (Sao Paulo, Brazil)Article
- Adapting the Connect-Home transitional care intervention for the unique needs of people with dementia and their caregivers: A feasibility study.Geriatric nursing (New York, N.Y.)Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundOlder adults that transfer from skilled nursing facilities (SNF) to home have significant risk for poor outcomes. Transitional care of SNF patients (i.e., time-limited services to ensure coordination and continuity of care) is poorly understood.
objectiveTo determine the feasibility and relevance of the Connect-Home transitional care intervention, and to compare preparedness for discharge between comparison and intervention dyads.
designA non-randomized, historically controlled design-enrolling dyads of SNF patients and their family caregivers.
settingThree SNFs in the Southeastern United States.
participantsIntervention dyads received Connect-Home; comparison dyads received usual discharge planning. Of 173 recruited dyads, 145 transferred to home, and 133 completed surveys within 3 days of discharge.
interventionThe Connect-Home intervention consisted of tools and training for existing SNF staff to deliver transitional care of patient and caregiver dyads. MEASUREMENTS: Feasibility was assessed with a chart review. Relevance was assessed with a survey of staff experiences using the intervention. Preparedness for discharge, the primary outcome, was assessed with Care-Transitions Measure-15 (CTM-15).
resultsThe intervention was feasible and relevant to SNF staff (i.e., 96.9% of staff recommended intervention use in the future). Intervention dyads, compared to comparison dyads, were more prepared for discharge (CTM-15 score 74.7 vs 65.3, mean ratio 1.16, 95% CI: 1.08, 1.24).
conclusionConnect-Home is a promising transitional care intervention for older patients discharged from SNF care. The next step will be to test the intervention using a cluster randomized trial, with patient outcomes including re-hospitalization.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.