The Influence of the Rural Transitions Nurse Program for Veterans on Healthcare Utilization Costs

Williams, Piper; Gilmartin, Heather; Leonard, Chelsea; McCarthy, Michaela S.; Kelley, Lynette; Grunwald, Gary K.; Jones, Christine; Whittington, Melanie D

doi:10.1007/s11606-022-07401-y

Cited by 2 publications

(1 citation statement)

References 23 publications

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“…The curriculum, including the CAPE assessments, was more resource-intensive than fully virtual training, which may make metrics such as return on investment difficult to calculate. This evaluation did not include the full costs of the training or implementation; however, we recently assessed the changes in cost from pre- to posthospitalization for enrolled veterans of TNP to better understand intervention costs 41. While this study did not include patient outcomes, our previous evaluation of TNP displayed that enrolled veterans were more likely to follow up with their primary care provider and experienced a reduction in mortality 42…”

Section: Discussionmentioning

confidence: 99%

Implementation and Evaluation of a Training Curriculum for Experienced Nurses in Care Coordination

Kelley

Broadfoot

McCreight

et al. 2023

Journal of Nursing Care Quality

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Background: High-quality transitional care at discharge is essential for improved patient outcomes. Registered nurses (RNs) play integral roles in transitions; however, few receive structured training. Purpose: We sought to create, implement, and evaluate an evidence-informed nursing transitional care coordination curriculum, the Transitions Nurse Training Program (TNTP). Methods: We conceptualized the curriculum using adult learning theory and evaluated with the New World Kirkpatrick Model. Self-reported engagement, satisfaction, acquired knowledge, and confidence were assessed using surveys. Clinical and communication skills were evaluated by standardized patient assessment and behavior sustainment via observation 6 to 9 months posttraining. Results: RNs reported high degrees of engagement, satisfaction, knowledge, and confidence and achieved a mean score of 92% on clinical and communication skills. Posttraining observation revealed skill sustainment (mean score 98%). Conclusions: Results suggest TNTP is effective for creating engagement, satisfaction, acquired and sustained knowledge, and confidence for RNs trained in transitional care.

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Section: Discussionmentioning

confidence: 99%

Implementation and Evaluation of a Training Curriculum for Experienced Nurses in Care Coordination

Kelley

Broadfoot

McCreight

et al. 2023

Journal of Nursing Care Quality

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Implementation of VA care coordination program to improve transitional care for veterans post-non-VA hospital discharge: an incremental cost analysis

Radcliff,

Ayele,

McCreight

et al. 2023

Implement Sci Commun

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Background The Veterans Affairs (VA) Healthcare System Community Hospital Transitions Program (CHTP) was implemented as a nurse-led intervention to reduce barriers that patients experience when transitioning from community hospitals to VA primary care settings. A previous analysis indicated that veterans who enrolled in CHTP received timely follow-up care and communications that improved care coordination, but did not examine cost implications for the VA. Methods A budget impact analysis used the VA (payer) perspective. CHTP implementation team members and study records identified key resources required to initially implement and run the CHTP. Statistical analysis of program participants and matched controls at two study sites was used to estimate incremental VA primary care costs per veteran. Using combined program implementation, operations, and healthcare cost estimates to guide key model assumptions, overall CHTP costs were estimated for a 5-year time horizon, including a discount rate of 3%, annual inflation of 2.5%, and a sensitivity analysis that considered two options for staffing the program at VA Medical Center (VAMC) sites. Results Implementation at two VAMCs required 3 months, including central program support and site-level onboarding, with costs of $34,094 (range: $25,355–$51,602), which included direct and indirect resource costs of personnel time, materials, space, and equipment. Subsequent annual costs to run the program at each site depended heavily on the staffing mix and caseload of veterans, with a baseline estimate of $193,802 to $264,868. Patients enrolled in CHTP had post-hospitalization VA primary care costs that were higher than matched controls. Over 5 years, CHTP sites staffed to serve 25–30 veterans per full-time equivalent transition team member per month had an estimated budget impact of $625 per veteran served if the transitional team included a medical social worker to support veterans with more social behavioral needs and less complex medical cases or $815 per veteran if nurses served all cases. Conclusions Evidence-based care coordination programs that support patients’ return to VA primary care after a community hospital stay are feasible to implement and run. Further, flexibility in staffing this type of program is increasingly relevant as the VA and other healthcare systems consider methods to reduce provider burnout, optimize staffing, reduce costs, and address other staffing challenges while improving patient care.

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The Influence of the Rural Transitions Nurse Program for Veterans on Healthcare Utilization Costs

Cited by 2 publications

References 23 publications

Implementation and Evaluation of a Training Curriculum for Experienced Nurses in Care Coordination

Implementation and Evaluation of a Training Curriculum for Experienced Nurses in Care Coordination

Implementation of VA care coordination program to improve transitional care for veterans post-non-VA hospital discharge: an incremental cost analysis

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