Introduction to CTM-3: What It Measures and Why

Transitions from hospital to home are a vulnerable time for patients. One tool used to evaluate these transitions is the 3-Item Care Transition Measure (CTM-3).

How the 3-item Care Transition Measure Works: Timing, Scoring and Domains

Developed to capture the patient’s voice in discharge evaluations, CTM-3 provides a concise alternative to the CTM-15.

The 3-item Care Transition Measure (CTM-3) is a survey that was developed to analyze patient-reported discharge readiness. Administered at least 2-days following discharge, the CTM-3 assesses the post-discharge care transition from an inpatient stay for any of a prespecified list of clinical episodes. This tool is a condensed version of the CTM-15, which has been widely used and assesses four distinct domains: (1) critical understanding, (2) preferences are important, (3) management preparation, and (4) care plan. The CTM-3 hones in on two of these domains – preferences are important and critical understanding. Once component of the Center for Medicare & Medicaid Services (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey from 2013-2025, CTM-3 is a hospital-wide measure typically administered to patients between 48 hours and 30 days following discharge from a hospital admission (per previous CMS requirements). 

At the health-system level, the CTM-3 can be cumulatively scored utilizing the average question score for all patients (i.e. sum of all scores for all three questions across all completed surveys divided by the number of questions answered). The final score is then converted to a scale of 1-100.

Strengths: Quick, Reliable Insight Into Discharge

This brief survey is a quick and simple gauge of patient-perceived discharge readiness following a hospital stay or emergency department visit. It has been demonstrated to have a significant relationship with readmission rates in the general population. 

Limitations: Considerations Before Relying on CTM-3

Though this tool has been demonstrated to correlate with readmission rates of the overall population following hospital admission or emergency department visit, this association is not consistent across all patient groups and may be related to patient characteristics such as prior admission and comorbidities. The CTM-3 has not been studied in other settings such as outpatient procedures or clinic visits. Furthermore, it is unclear whether the CTM-3 is modifiable, meaning that even implementation of intensive programs designed to prepare patients for discharge might not provide improvement in CTM-3.

CTM-3 Licensing and Cost: Free but With Attribution Requirements

No specific licensure is required but users are required to include the following statement on each page where CTM items are included, “The CTM is (c) to Eric A. Coleman, MD, MPH with all rights reserved”.

No fees are required.

Final Thoughts: Is CTM-3 Still Relevant?

This short questionnaire provides a high-level view of patient readiness for discharge within a health system. While system-level measure was once critical for meeting mandatory requirements by CMS, it  doesn’t provide patient-level actionable guidance and  further research is required to determine modifiability of this measure through systemic interventions.

Sources    |    [[1] 3-Item Care Transition Measure (CTM-3)]    |    [[2] Psychometric Evaluation of the Care Transition Measure in TRACE‐CORE]    |    [[3] CMS Quality Measures Fact Sheet]    |    [[4] Care Transition Measure Reporting]   |   [[4] Is the Care Transitions Measure Associated with Readmission Risk?]