Results

From 2012-2013, 26 cross continuum healthcare organizations and 6 schools of nursing in Western Massachusetts piloted the curriculum with 350 nurses & nursing students. Based on our pilot evaluation, our partners demonstrated that CTEP contributes to important outcome indicators including reducing avoidable 30 day hospital readmission rates and improved patient-centered care. Read more about our partners’ success stories. The pilots also demonstrate results related to knowledge, mutual respect, communications and nursing practice.

  • Knowledge: Pilots reported the most valuable CTEP outcome was its impact on nurses’ knowledge and ability to improve care transitions. All service pilots increased knowledge scores from pre- to post-test with four of the increases being statistically significant.
  • Mutual Respect: All pilot sites affirmed the value of bringing nurses from across the continuum together to learn from/with each other as a strategy to increase mutual respect and identify common patient-centered goals.
  • Communications: 66% of pilots demonstrated an emergence of nurse-led quality improvement initiatives focused on improving communication and collaboration. Cross continuum relationships and ongoing communications have improved as a result of CTEP participation.
  • Nursing Practice: Nearly three-fourths of learners participated in Patient Tracer experiences and identified its positive impact on their care transitions work. 63% of pilots reported evidence of changes in nursing practice that supported improvements of care transitions.

All six of the service pilot sites cite CTEP as a unique education program that equips nurses in all care settings and all roles with the foundational knowledge, skills and attitudes required to lead and improve care transitions. All pilots recommend implementing CTEP to other Massachusetts healthcare providers.