LTQA chair Mary Naylor and her colleagues Linda Aiken, Ellen Kurtzman, Danielle Olds and Karen Hirschman have authored a piece in the newest edition of Health Affairs called “The Importance of Transitional Care in Achieving Health Reform.”

Currently, one in five elderly patients discharged from a hospital is readmitted within a month. Seeking to address the human and substantial financial burden of revolving door hospital readmissions, the Affordable Care Act proposes a number of initiatives to improve care and health outcomes and reduce costs for the growing population of chronically ill people in the U.S. While transitional care is a central theme in these provisions, there is little information available to guide those responsible for implementing these important opportunities.

To bridge the gap, researchers at the University of Pennsylvania School of Nursing reviewed existing programs in order to determine what works, for whom and for how long. They discovered “a robust body of evidence” that transitional care can improve health outcomes and reduce hospital readmissions. Their paper published in the current edition of Health Affairs, the major public policy journal, highlights a range of solutions to reduce avoidable hospitalizations and health care costs.

University of Pennsylvania School of Nursing Press Release, April 7, 2011