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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000399302.75537.5d
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NewsCAP: Nurses will play a prominent role in applying evidence-based strategies to transitional care

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Nurses will play a prominent role in applying evidence-based strategies to transitional care under the Patient Protection and Affordable Care Act of 2010, according to an analysis of 21 clinical trials reported in the April issue of Health Affairs. The studies evaluated chronically ill adults transitioning from acute care hospitals to homes or skilled nursing, rehabilitation, and long-term care facilities. Among the interventions that most effectively reduced readmission rates were in-person home visits, comprehensive discharge planning with follow-up interventions based on patient and caregiver goals, individualized care planning, comprehensive medication review and management, and daily home telephone or videophone monitoring. Most of these tasks rely on nurses as clinical leaders or care managers. Such programs are cost-effective and improve quality of life and patient satisfaction.

© 2011 Lippincott Williams & Wilkins, Inc.

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