Evaluation of a nurse practitioner-led transitional care program: The effects on 30-day Medicare readmission rates and patient satisfaction scores.

Background: Data suggest that nurse practitioner (NP)-led transitional care models can reduce 30-day readmission rates. It remains unclear if transitional care has any impact on Press Ganey's Hospital Consumer Assessment of Health Provider and Systems (HCAHPS) patient satisfaction scores.

Local Problem: A transitional care encounter program (TCEP) was designed and implemented by an NP at an internal medicine private practice in response to an increase in Medicare 30-day readmission rates and lower HCAHPS results.

Evaluation of a nurse practitioner-led transitional care program.

Background: Transitional care management (TCM) is a growing field in the delivery of post hospital discharge care. Current data suggest that implemented nurse practitioner (NP)-led transitional care models can be useful in reducing 30-day readmission rates. However, there is lack of data regarding the costs involved to implement and sustain a transitional care model.