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Background The Australian Transitional Care Program (TCP) is a national, time limited, reablement program provided at home or within a facility aiming to facilitate safe discharge home and delay entry to Residential Aged Care (RAC). The aim of the study was to identify factors that contribute to longer facility-based TCP lengths of stay (LOS) allowing for early identification and proactive delivery of targeted interventions to optimise timely outcomes. Method A retrospective cohort study on 512 TCP recipients admitted to a large Western Australian TCP provider from 1st Nov 2023 to 30th June 2025. Univariate analysis identified variables of interest for modelling length of stay. Multivariate mixed effects negative binomial regression determined which collection of variables was associate with LOS. Results Regression modelling identified a number of key factors which predicted longer LOS including patients who live with others at the time of TCP, those who discharge to RAC, and incidences of falls or changed behaviour while receiving TCP. Age, sex, associated comorbidities and Modified Barthel Index scores on admission and discharge were factors not significantly related to increased lengths of stay. Conclusion This study identified four factors that predict longer LOS in facility-based TCP. Given TCP’s time limited nature and the associated effects of delayed discharge on patient affect and patient flow, service providers must ensure their TCP models of care meet the needs of its population. Understanding who may be at risk of longer stays supports TCP services to be personalised and provided in a timely manner with the focus on mitigation strategies.
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