Which transitions count? A systematic hermeneutic review of the literature on transitions of care

BACKGROUND: Transitions of care are defined as critical moments along the care continuum for patients as they navigate changes in their health status or level of care. Researchers suggest that the existing research on transitions of care is largely descriptive and lacking in theoretical depth, which limits its application to different clinical contexts. AIM: We therefore aim to review the existing literature and theoretical frameworks on transitions of care, with a focus on primary care settings. METHOD: We undertook a systematic hermeneutic review - an approach that emphasises analytical reading, including identifying key concepts and building interpretations across a large and heterogeneous body of literature. Our initial search yielded 1640 articles, and we included 54 sources in our review. RESULTS: Despite interdisciplinary discussions, the main narratives of transitions of care centered around hospitals, with limited consideration for transitions in community settings. Moreover, using re-hospitalisation admission rates as the primary metric to measure the effectiveness of transitions of care initiatives fails to capture the negotiations required by patients and staff. This highlights the undercurrent of a positivist and biomedical approach, and the influence of broader health policy in shaping the methods and narratives used to define transitions. CONCLUSION: We consider this gap pertinent, given the increasing complexity of care delivered in community settings through remote chronic care models. In response, we suggest further engagement with theory to deconstruct our focus on settings and re-conceptualise transitions of care, which are also marked by changes in practices, materials, and people.