The Care Transitions Program

Eric A. Coleman, MD, MPH - Health Care Services for Improving Quality and Safety during Care Hand-offs

Evidence and Adoption

Evidence and Adoption

The CTI® is uniquely focused on providing patients and family caregivers with the skills, confidence, and tools they need to assert a more active role in their care and ensure that their needs are met. Unlike most of the current approaches available, the CTI® was co-designed with patients and families and was evaluated using the most rigorous scientific approach – randomized controlled trials.

grandmother and grandaughter looking at a computer screen

Our Key Findings

Patients who received the CTI® were significantly less likely to be readmitted to the hospital, and the benefits were sustained for five months after the end of the one-month intervention.

Thus, rather than simply managing post-hospital care in a reactive manner, imparting self-management skills pays dividends long after the program ends. Anticipated net cost savings for a typical Transitions Coach® panel of 350 chronically ill adults with an initial hospitalization over 12 months is conservatively estimated at $365,000. Patients who received this program were also more likely to achieve self-identified personal goals around symptom management and functional recovery.

Looking to be successful under bundled payment or ACOs? Here is why the CTI® is a great fit!

20-50%

reduction in hospital readmissions

When organizations are trained by the Care Transitions Program® and follow model fidelity, they can expect reductions in readmission rate of 20-50% (reduction depends on current readmission rate). Reducing readmissions can also improve your CMS Star rating.

$365K

net saving per Transitions Coach®

An Independent evaluator estimates a $110 PMPM cost savings.

Injured person icon

52%

Patients meeting or exceeding self-identified personal care goals

The majority of patient goals reflect better quality of life and improved functional status.

Health care services for improving quality care and safety of patients during transitions across care settings

Free viewers are required for some of the attached documents.
They can be downloaded by clicking on the icons below.
Download Acrobat Reader Download Flash Player Download QuickTime Download Windows Media Player Download Microsoft Silverlight
Sitemap

The Care Transitions Intervention® and all of its materials are the property of the Care Transitions Program®. All content on this website is © to Eric A. Coleman, MD, MPH

The Care Transitions Program® is solely authorized to provide training on the Care Transitions Intervention®. If another entity offers to train your organization, please contact us.

The Care Transitions Intervention (CTI)® has been carefully designed and tested and modifications or extracting parts of the model is generally not advised, particularly if the provider or organization is seeking to replicate the CTI's® proven outcomes. The Care Transitions Program® discourages organizations from referring to models that do not adhere to model fidelity for the CTI® as "modified from", "based on" or "derived from" the Care Transitions Intervention® , CTI® or Coleman model.

Disclaimer: The Care Transitions Program® and its personnel assume no liability or risk for use of model, materials or any advice explicit or implicit.