The Bridge Model of Transitional Care
An Effective Practice
Description
The Bridge Model is an intervention that assists older adults in safely transitioning from the hospital back to their homes. Important features of the intervention include that it is person-centered, social-work led and provides transitional care at an interdisciplinary level. The Bridge Model combines 3 important components: care coordination, case management, and patient engagement.
Goal / Mission
The goal of The Bridge Model of Transitional Care is to help aging adults transition from the hospital back to their homes and communities safely.
Impact
The Bridge Model of Transitional Care can help lower hospital re-admission rates as well as improve primary care engagement 30 days after being discharged from the hospital.
Results / Accomplishments
The Bridge Model has been subjected to many studies and trials. Key findings include: lower re-admission rates, improved primary care engagement following hospital discharge and greater patient satisfaction.
An evaluation of the Bridge Model at one site participating in the 2012–2014 Community-based Care Transitions Program found a 30.7% lower rate of 30-day readmissions, a 9.4% lower rate of 60-day readmissions, and a 13.9% lower rate of 90-day readmissions, as well as increased attendance of post-discharge physician appointments, in comparison to the baseline.
An evaluation of the Bridge Model at one site participating in the 2012–2014 Community-based Care Transitions Program found a 30.7% lower rate of 30-day readmissions, a 9.4% lower rate of 60-day readmissions, and a 13.9% lower rate of 90-day readmissions, as well as increased attendance of post-discharge physician appointments, in comparison to the baseline.
About this Promising Practice
Primary Contact
Topics
Health / Older Adults
For more details
Target Audience
Adults, Older Adults