Mapa, Angeline Z.. Impact of transitional care management program in relation to 30-day hospital readmissions, emergency department visits, and financial revenues. Retrieved from https://doi.org/doi:10.7282/t3-ztxe-wq43
DescriptionPurpose of the Project: Transitional care management is a reimbursable outpatient provider visit used to provide continuity of care and to manage patients’ health post-acute care discharge. This DNP project was designed to retrospectively evaluate the effectiveness of an enhanced TCM program at a family health center.
Methodology: A manual chart review of N = 300 transitional care management patients was performed. It quantitatively collected 3 years’ worth of data to assess if the improved transitional care management program was effective in decreasing hospital readmissions and emergency department visits and if it increased the family health center’s financial revenues.
Results: The modified transitional care management program effectively increased phone calls post-acute care discharge and financial reimbursements. However, the other outcomes of interest were not statistically significant between the groups—hospital readmissions, emergency department visits, and time (in days) to transitional care appointments.
Implications for Practice: Staff education regarding transitional care management, implementing a dedicated team, and routine program evaluation effectively increase patient communication and financial revenues. Further projects involving a multicomponent and multidisciplinary transitional care management program and its relation to improved patient outcomes are recommended.