Study will test transitional care model in four health systems

In a new study funded by Arnold Ventures, researchers at Penn Nursing will attempt to replicate the economic and health benefits associated with the transitional care model (TCM) by evaluating the model’s effects in four health systems. The model employs an advanced practice registered nurse to work with patients, their family caregivers and their health care providers to create a coordinated plan of care between the hospital and home. “TCM has very promising evidence of sizable reductions in rehospitalizations and net health care costs among Medicare beneficiaries,” said Erin Crossett, evidence-based policy manager at Arnold Ventures. If these positive outcomes can be reproduced, the aim is to spread the model to other health care systems across the United States.