Avoidable Care Transitions: A Consensus-Based Definition Using a Delphi Technique

Rustem Makhmutov, Gabriele Meyer, Moriah E. Ellen, Steffen Fleischer

Research output: Contribution to journalArticlepeer-review


Background and Objectives: Older adults are at increased risk of frequent transitions between care settings, even though some care transitions are avoidable. The term “avoidable care transitions” is not clearly defined in the research literature. This study aimed to find a consensus-based definition for “avoidable care transitions.” Research Design and Methods: This study was conducted as part of the TRANS-SENIOR research network. A 4-round Delphi survey was based on a literature review that identified existing definitions of “avoidable care transitions.” Articles in MEDLINE via PubMed and CINAHL were searched. In total 95 references were included, and 106 definitions were identified. Definitions were coded to find themes, resulting in 3 themes with 2 codes for each. Results: In total, 99 experts from 9 countries were invited, and the response rates in Delphi Rounds 1, 2, 3, and 4 were 37.5%, 19.1%, 33.3%, and 23.3%, respectively. Upon reaching the predefined minimum of 90% agreement, the following definition was declared as final: “Avoidable care transitions (a) are without significant patient-relevant benefits or with a risk of harm outweighing patient-relevant benefits and/or (b) are when a comparable health outcome could be achieved in lower resource settings using the resources available in that place/health care system, and/or (c) violate a patient’s/informal caregiver’s preference or an agreed care plan.” Discussion and Implications: Consensus on a definition for “avoidable care transitions” was reached by a multidisciplinary and international panel of experts comprising researchers and providers. The resulting definition consists of 3 distinct dimensions relating to the balance of benefit and harm to a patient, resource consumption, and a patient’s or informal caregiver’s preferences. The new definition might enhance the common understanding of avoidable care transitions and is now ready for application in research and quality and safety management in health care. Translational Significance: The concept of “avoidable care transitions” is mainly interpreted from a single perspective: the health care system’s or clinician’s perspective. Nevertheless, no consensus on defining avoidable care transitions has been reached. A systematically developed definition seemed necessary. The resulting consensus-based definition embraces multiple dimensions and addresses the shortcomings of the former definitions. It can guide patients, clinicians, and policymakers in decision-making and lay the groundwork for practical solutions aimed at identifying and reducing avoidable care transitions, thus resulting in positive implications at the clinical, system, and patient levels. The new definition may also improve comparability among future studies.

Original languageAmerican English
Article number1
JournalInnovation in Aging
Issue number8
StatePublished - 1 Jan 2023


  • Literature review
  • Survey
  • Terminology

All Science Journal Classification (ASJC) codes

  • Health(social science)
  • Life-span and Life-course Studies
  • Health Professions (miscellaneous)


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