Mary Naylor’s Innovation in Transitional Care
When it comes to improving quality and accessibility in health care while reducing costs, few have the record of nurse researcher Mary Naylor, PhD, RN, FAAN. As the Marian S. Ware Professor in Gerontology at Penn Nursing and Director of the NewCourtland Center for Transitions and Health, Dr. Naylor has developed, and demonstrated through multiple NIH-funded clinical trials, the health and economic benefits of the Transitional Care Model (TCM). The TCM is implemented by advanced practice nurses supported by a care team that has been proven to help at risk chronically ill older adults and their family caregivers gain the knowledge, skills and resources to successfully recover from acute illnesses, and prevent avoidable and costly care, while reducing total costs of care.
With a multidisciplinary team of clinical scholars and health services researchers at Penn, Dr. Naylor has led foundation-sponsored implementation efforts of the TCM in multiple health systems and communities throughout the U.S., supporting systems’ efforts to improve the care of chronically ill older adults. These translational efforts have demonstrated that the health and economic benefits generated in rigorous clinical trials can be replicated in clinical practice. Additionally, the evidence generated from her body of work has contributed to changes in health care policies. Dr. Naylor has spread her work globally to demonstrate how the knowledge her research has generated can be used to redesign care systems.
Dr. Naylor is a member of the National Academy of Medicine, a Fellow of the American Academy of Nursing, and a member of numerous advisory boards and councils. She has received many honors for her scholarly contributions, including AcademyHealth’s Distinguished Investigator Award in 2016. Through her research and teaching, Dr. Naylor continues to mentor and inspire students, from first-year undergraduates to postdoctoral research fellows.