The Importance of Transitional Care In Achieving Health Reform

In an article in Health Affairs (April 2011), Mary D. Naylor systematically reviews twenty-one randomized experiments that tested interventions that help the chronically ill during transitions in care and identified nine that successfully demonstrated a decrease in hospital readmissions. Many of the successful interventions shared similar features, such as assigning a nurse as the clinical manager or leader of care and including in-person home visits to discharged patients.

Under the Affordable Care Act of 2010, a variety of transitional care programs and services have been established to improve quality and reduce costs. Based on these findings, the authors recommend several strategies to guide the implementation of transitional care under the Affordable Care Act, such as encouraging the adoption of the most effective interventions through such programs as the Community-Based Care Transitions Program and Medicare shared savings and payment bundling experiments.

Read the full article, here.