Mary Naylor's 'Transitional Care' System Spotlighted

Mary Naylor's 'Transitional Care' System Spotlighted

Pairs Nurses With Elderly Patients After Discharge
Mary Naylor's "Transitional Care Model" that pairs nurses with elderly patients from the time they enter the hospital to up to 90 days after they are discharged
Mary Naylor
Mary Naylor of Penn's School of Nursing

is the subject of a National Journal article.

Fewer readmissions
Naylor, PhD, RN, FAAN, is a Professor of Gerontology at the University of Pennsylvania School of Nursing who has spent two decades developing and researching her transitional care concept and testing it in Philadelphia-area hospitals. One analysis of 730 heart-failure patients who had nurses "following them home" found a 20% decrease in rehospitalization rates.

"The way to avoid costly services is to prepare people and provide them with the resources they need," Naylor told the magazine. "It's about making things simpler and getting people on the right plan of care."

Naylor is also an LDI Senior Fellow and Director of the Nursing School's NewCourtland Center for Transitions and Health.