Case study 9: Partners at care transitions measure
Global State of Patient Safety 2023
Country where the case study originated highlighted in red. Where relevant, additional countries where this programme has been implemented are highlighted in blue.
What is it?
The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire to assess the quality and safety of care transitions from hospital to home for older patients (over 65 years old). The measure has been adopted by teams around the world, including in Denmark, China, Sweden and Bahrain, primarily for research or service evaluation purposes.
PACT-M asks patients to report on:
- How prepared they were for being at home after a hospital stay (measured at 7-10 days after discharge) and,
- How well they are managing their care at home (measured at 30 days after discharge).
Examples of statements that patients are asked to agree or disagree with (on a five-point scale) include, Before leaving the hospital, I knew what arrangements had been made to support me at home, and, I know what to do and who to contact if my health gets worse, respectively.
Why was it developed?
The transition of older patients from hospital to their own home is a period of high risk, particularly for those with complex needs. Such patients have been shown to be at greater risk of emergency readmission into hospital within the first 30 days of discharge. Research has also shown that patients and caregivers often do not feel prepared to manage their own care, and feel frustrated by poor preparation for their discharge.
Prior to the development of PACT-M, there was no systematic way of assessing the experience, quality and safety of these transitions in a UK context.[1] While other similar measures existed (for example, the Care Transition Measure), they tended to focus on specific care settings or only on the hospital discharge process itself.
How can it be adopted?
Some adaptation may be required to ensure it is suited to the new context in which it is being implemented. For example, teams from Denmark and Sweden have translated it into their own languages, but also checked with the research team to see if some modifications to the content could be made to reflect the way some services are designed and delivered in their countries:
“We’re not saying it’s perfect. We’re saying, ‘this is a new measure, it’s seems to work well, [but] people should tweak it and adapt it to their local context.”
Teams aiming to evaluate and improve transition quality may use the PACT-M to identify areas for improvement, for example by exploring the number of patients that disagree or strongly disagree with the statements. Teams may also want to decide which area of care they’re most interested in – how the discharge is handled, or how care is being managed at home - and to prioritise use of that questionnaire.
How can the measurement of patient safety be improved?
“We tend to collect information about safety in a single place. We capture information about how a hospital performed, or how a primary care practice performed, but what safety is all about from a patient perspective is, ‘how am I safe across my lifespan when I’m being cared for by different services?”.
Key resources and contact details
Validation of the Partners at Care Transitions Measure (PACT-M): assessing
the quality and safety of care transitions for older people in the UK
Professor Rebecca Lawton: R.J.Lawton@leeds.ac.uk
[1] The Care Transition Measure (CTM) was the primary means of assessing care transitions, developed in the US, but may not necessarily reflect the types of challenges faced by UK populations. Further information: https://www.jstor.org/stable/3768223. Other measures have been developed, but tend to be site specific, for example, for a nursing home or primary care clinic, rather than the transition between hospital and home.
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