The American Academy of Nursing has designed a Penn School of Nursing transitional care model as an Edge Runner, marking it as an evidence-based model of care with proven outcomes.
The Nursing School’s THRIVE: Equity-focused Transitional Care Model is a 30-day-long intervention for adults insured by Medicaid and ensures a smooth transition from the hospital back to one’s home. It aims to address both health and social needs and includes home care, virtual case management, and assistance from nurses at every stage of the recovery process.
To be recognized as an Edge Runner, a model of care must lead to significant clinical, financial, community, and policy outcomes. THRIVE fulfilled all of the required criteria and is one of six programs to be given the designation this year.
According to the American Academy of Nursing, THRIVE showed significant improvements in clinical and financial outcomes since April 2019. Medicaid-insured adults who participated in THRIVE experienced fewer readmissions, at 14.3%, compared to a 28.4% readmission rate among adults who did not participate. This reduction in readmissions is estimated to save hospitals over $225,000 per year.
The model’s executive director is Margo Brooks Carthon, the Tyson Family Endowed Term Chair for Gerontological Research and professor in the Department of Family and Community Health. Carthon also serves as the associate director of the Center for Health Outcomes and Policy Research and fellow at the Leonard Davis Institute of Health Economics.
“THRIVE’s designation as an Academy Edge Runner is a testament to our team’s dedication to transforming health care delivery to ensure that it works for the most underserved,” Carthon said in the Nursing School announcement.
The program leads of each designed model of care will be honored this October at the 2024 Health Policy Conference in Washington. The conference, which has the theme “Courageous Transformations Towards an Equitable Future,” will discuss virtual health trends, community engagement, and the importance of nursing.
“The Academy is proud to designate these solution-oriented initiatives as Edge Runners. The diverse focus of these models highlights the wide range of services, vital support, and innovative team-based approaches that the nursing profession provides,” Academy President Linda Scott said in the announcement. “Each Edge Runner model demonstrates how nurses are pioneers in addressing important health care challenges.”
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