Moving beyond readmission penalties: creating an ideal process to improve transitional care

J Hosp Med. 2013 Feb;8(2):102-9. doi: 10.1002/jhm.1990. Epub 2012 Nov 26.


Hospital readmissions are common and costly; this has resulted in their emergence as a key quality indicator in the current era of renewed focus on cost containment. However, many concerns remain about the use of readmissions as a hospital quality measure and about how to reduce hospital readmissions. These concerns stem in part from deficiencies in the state of the science of transitional care. A conceptualization of the "ideal" discharge process could help address these deficiencies and move the state of the science forward. We describe an ideal transition in care, explicate the key components, discuss its implications in the context of recent efforts to reduce readmissions, and suggest next steps for policymakers, researchers, healthcare administrators, practitioners, and educators.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Continuity of Patient Care / standards*
  • Continuity of Patient Care / trends
  • Humans
  • Patient Discharge / standards
  • Patient Discharge / trends
  • Patient Readmission / standards*
  • Patient Readmission / trends
  • Quality Indicators, Health Care / standards*
  • Quality Indicators, Health Care / trends
  • Quality of Health Care / standards
  • Quality of Health Care / trends