• Farhana Md Yusof Ministry of Health Malaysia, c/o Klinik Kesihatan Sungai Tekam Utara, 27060 Jerantut, Malaysia
  • Chai-Eng Tan Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia,Jalan Yaakob Latif, Cheras 56000,Kuala Lumpur, Malaysia



Transitional care, quality of health care, primary health care, patient discharge


Quality of transitional care affects healthcare spending and service use. Poor transitional care is associated with adverse effects such as medication error and risk of unnecessary readmission. The objective of this study is to evaluate patients’ perception of quality of transitional care from a public tertiary hospital to a public health clinic in Negeri Sembilan. A cross-sectional study was conducted involving 307 respondents from the public health clinic following discharge from the hospital from July to September 2018.Patient’s perception of quality of transitional care was measured using the Care Transitional Measure (CTM 15®) questionnaire. The response rate for this study was 90.6%. The mean CTM-15® score was 73.1 (±13.03) out of a scale of 1 to 100. The mean scores for the various domains were: Critical understanding was 73.3 (±14.33), Preferences important was 71.9 (±14.99), Management preparation was 74.0 (±14.53), and Care plan 73.3 (±14.75).  Multiple linear regression showed that age was a significant independent predictor for the CTM-15® scores where elderly patients had poorer scores than young adults (adjusted R2=0.104, p<0.001).In conclusion, the perceived quality of transitional care between the public general hospital and health clinic was good but decreased with patient’s age. This could be due to complexity of the patient’s problems upon discharge.


1. Coleman EA, Boult C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003;51(4):556-557.

2. Scales DC, Fischer HD, Li P, et al. Unintentional Continuation of Medications Intended for Acute Illness After Hospital Discharge: A Population-Based Cohort Study. J Gen Intern Med. 2016;31(2):196-202.

3. Goldstein JN, Hicks LRS, Kolm P, Weintraub WS, Elliott DJ. Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center. J Gen Intern Med. 2016;31(7):732-738.

4. Forster AJ, Murff HJ, Peterson JF. The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital. Ann Intern Med. 2003;138(3):161.

5. WHO. The High 5s Project: Interim Report. 2014:123.

6. Barach P, Gademan P, Dudzik-urbaniak E, Flink M. Organizational Culture An Important Context for Addressing and Improving Hospital to Community Patient Discharge. Med Care. 2013 Jan;51(1):90-8

7. Hesselink G, Schoonhoven L, Plas M, Wollersheim H, Vernooij-Dassen M. Quality and safety of hospital discharge: A study on experiences and perceptions of patients, relatives and care providers. Int J Qual Heal Care. 2013;25(1):66-74.

8. Kattel S, Manning DM, Erwin PJ, Wood H, Kashiwagi DT, Murad MH. Information Transfer at Hospital Discharge: A Systematic Review. J Patient Saf. 2016 Jan 7. [Epub ahead of print]

9. Corona-lobos L, Harduin M, Boivin C. Psychosocial Factors Associated with Hospital-to-Home Transitions of Older People?: A Review. J Nurs Care ,2018;7(4).

10. Desai AD, Durkin LK, Jacob-Files EA, Mangione-Smith R. Caregiver Perceptions of Hospital to Home Transitions According to Medical Complexity: A Qualitative Study. Acad Pediatr. 2016;16(2):136-144.

11. Sivasampu, Sheamini & Noh, Kamaliah & May Chien, Chin. (2015). Quality and Costs of Primary Care (QUALICOPC)- Malaysia Phase 1 Report 2015.

12. Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005;143(2):121-128.

13. Moore C, McGinn T HE. Tying up loose ends: discharging patients with unresolved medical issues. Arch Intern Med. 2007 Jun 25;167(12):1305-11.

14. Allen J, Hutchinson AM, Brown R, Livingston PM. Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Heal Serv Res. 2014;14:346.

15. Jencks SF, Williams M V., Coleman EA. Rehospitalizations among patients in the Medicare Fee-for-Service Program. N Engl J Med. 2009;360(14):1418-1428.

16. Wang Y, Yang F, Shi H, Yang C, Hu H. What type of transitional care effectively reduced mortality and improved ADL of stroke patients? A meta-analysis. Int J Environ Res Public Health. 2017;14(5):1-17.

17. Laugaland K, Aase K, Barach P. Interventions to improve patient safety in transitional care - A review of the evidence. Work. 2012;41(suppl.1):2915-2924.

18. Coleman EA, Mahoney E, Parry C. Assessing the quality of preparation for posthospital care from the patient’s perspective: the care transitions measure. Med Care. 2005;43(3):246-255.

19. Bakshi AB, Wee SL, Tay C, et al. Validation of the care transition measure in multi-ethnic South-East Asia in Singapore. BMC Heal Serv Res. 2012;12:256.

20. Yoshimura M, Sato M, Sumi N. Validity and reliability of the Japanese version of the Care Transitions Measure. Int J Health Plann Manage. 2018 Apr;33(2):380-390

21. Anatchkova MD, Barysauskas CM, Kinney RL, et al. Psychometric evaluation of the Care Transition Measure in TRACE-CORE: do we need a better measure? J Am Hear Assoc. 2014;3(3):e001053.

22. Lim J. Sustainable Health Care Financing: The Singapore Experience. Glob Policy. 2017;8(2):103-109.

23. Shan L, Li Y, Ding D, et al. Patient satisfaction with hospital inpatient care: Effects of trust, medical insurance and perceived quality of care. PLoS One. 2016;11(10):1-18.

24. Arbaje AI, Wolff JL, Yu Q, Powe NR, Anderson GF, Boult C. Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. Gerontologist. 2008;48(4):495-504.

25. Storm M, Siemsen IMD, Laugaland K, Dyrstad DN, Aase K. Quality in transitional care of the elderly: Key challenges and relevant improvement measures. Int J Integr Care. 2014;14(May):e013.

26. Mesteig M, Helbostad JL, Sletvold O, Røsstad T, Saltvedt I. Unwanted incidents during transition of geriatric patients from hospital to home: A prospective observational study. BMC Health Serv Res. 2010;10:1-9.

27. Boyle J, Speroff T, Worley K, et al. Low Health Literacy Is Associated with Increased Transitional Care Needs in Hospitalized Patients. J Hosp Med. 2017;12(11):918-924.

28. Berkman ND, Donahue K, Berkman ND, et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011 Jul 19;155(2):97-107

29. Lee HY, Lee J, Kim NK. Gender Differences in Health Literacy Among Korean Adults: Do Women Have a Higher Level of Health Literacy Than Men? Am J Mens Health. 2015;9(5):370-379.

30. Sheikh H, Brezar A, Dzwonek A, Yau L, Calder LA. Patient understanding of discharge instructions in the emergency department: do different patients need different approaches? Int J Emerg Med. 2018;11(1).

31. Van Der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E. The relationship between health, education, and health literacy: Results from the dutch adult literacy and life skills survey. J Health Commun. 2013;18(suppl. 1):172-184.

32. Kondo N, Sembajwe G, Kawachi I, Van Dam RM, Subramanian S V., Yamagata Z. Income inequality, mortality, and self rated health: Meta-analysis of multilevel studies. BMJ. 2009;339(7731):1178-1181.

33. Morales LS, Dial TH, Pincus HA, Haviland MG. Race/Ethnicity, Socioeconomic Status, and Satisfaction With Health Care. Am J Med Qual. 2005;20(4):195-203.

34. Pickard KE, Ingersoll BR. Quality versus quantity: The role of socioeconomic status on parent-reported service knowledge, service use, unmet service needs, and barriers to service use. Autism. 2016;20(1):106-115.

35. Division of Family Health Development Ministry of Health Malaysia. Perinatal Care Manual. third edition. 2013:136-162.

36. Karliner LS, Auerbach A, Nápoles A, Schillinger D, Nickleach D, J P-SE. Language barriers and understanding of hospital discharge instructions. Med Care. 2012;50(4):283-289.

37. Mosallam RA, Metwally S. Patients’ views on the quality of transitional care at a health insurance hospital in Alexandria, Egypt. J Egypt Public Health Assoc. 2014;89(2):74-80.




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