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Role of Context in Care Transition Interventions for Medically Complex Older Adults: A Realist Synthesis Protocol

Approximately 30-50% of older adults have two or more conditions and are referred to as multimorbid or complex patients, who require extensive health care resources and often require visits to various healthcare providers. Managing the transition between these providers and settings is difficult within current healthcare delivery systems, and these transitions typically result in fragmented care. Previous evidence has primarily focused on the implementation of care transition interventions to improve continuity of care for patients discharged from hospital to either home, home with care or another institution. However, emerging findings suggest that the effectiveness of these models is contingent on contexts, and that the current evaluations of these models have limited utility in deciding interventions for particular patient groups or care environments. Ultimately, this may result in stakeholders implementing seemingly effective interventions into contexts where they may not be effective.