The eighty-four percent retention rate in the study for the entire two years is noteworthy. The number of older people is increasing in our society, and healthcare professionals and family caregivers need workable strategies to help patients live healthy, independent lives for as long as possible. Researchers have tested a transitional care model on older people hospitalized with common medical and surgical problems. The model involves advanced practice nurses who conduct comprehensive hospital discharge planning, including determining the patient's care needs outside the hospital, with follow-up in the home. Findings indicate that the number of days in the hospital was reduced by 65 percent, and rehospitalizations and costs to the healthcare system were reduced by 48 percent for these patients.
Investigators continue to test the model on patients with heart failure.
These patients typically have a poor prognosis and the highest rate of hospitalization of all patient groups. It is also difficult for many of them to change risky behaviors, which underscores the importance of home follow-up. Research is also directed at family caregivers, who are helping undergird the healthcare system. The demand for these caregivers is increasing. A survey by the Center for Advancement of Health found that one in four U.S. households provides some type of care for people with chronic conditions.