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

Transitional care is a critical component of healthcare quality and patient outcomes. This retrospective observational study aimed to descriptively identify transitional care service implementation patterns for patients with ischemic stroke in Japanese acute care hospitals and examine their associations with hospital-level characteristics using the Japan Medical Data Center hospital-based claims database. A total of 14,129 patients aged ≥40 years admitted for ischemic stroke and discharged from Japanese acute care hospitals between April 2022 and August 2023. We examined 10 transitional care services from billing claims and grouped them into 4 domains. These 4 binary indicators were used in a Latent Class Analysis to identify unobserved implementation patterns. Conditional inference tree analysis, incorporating hospital- and patient-level variables, was applied to assess characteristics associated with each pattern. Sensitivity analyses using fractional logit regression were conducted to address uncertainty in pattern assignment. Three distinct transitional care service implementation patterns were identified. Two patterns emphasized patient/family education and information transfer, while the third involved resource-intensive services, including discharge planning and structured coordination with post-discharge providers. These patterns were significantly associated with the number of beds and patient age (all P < .01). Sensitivity analyses confirmed the number of beds as a consistent, significant factor across patterns. Transitional care service implementation patterns varied across hospitals, likely reflecting structural characteristic differences, particularly hospital size. Larger hospitals tended to implement more comprehensive combinations of transitional care services. These findings highlight how structural characteristics may contribute to variation in transitional care service delivery.