What Is Transitional Care Management?

It’s a lesson you learn in medical school—patients who don’t get the right support after surgery or treatment often end up relapsing. But once you start seeing it firsthand in your own practice, it becomes clear that you need to offer solutions that bridge the gap between treatment and recovery.

Collectively, these solutions are known as transitional care management (TCM). Here’s what you need to know about what TCM is and how it helps patients.

What Is Transitional Care Management?

Transitional care management services are any forms of assistance that help patients avoid setbacks during the period between treatment and recovery. Typically, TCMs are only used after someone has been treated in an inpatient setting; in other words, if treatment was rendered during a typical office visit, transitional care isn’t likely to be part of the equation. However, there are exceptions to this rule, such as treating injuries with outpatient physical therapy.

What Does Transitional Care Management Do?

The goal of TCM is to keep patients on track for achieving good results from treatment. Many conditions can easily be managed from home after surgery or initial treatment, if the correct supervision and support is in place.

During the transition between inpatient and outpatient care, patients often lose their rhythm. This can present in a variety of ways. From forgetting to take their medications to pushing themselves too hard while still healing, patient errors can have devastating consequences, often leading to relapse.

Transitional care management preserves the continuity of care that began at the medical facility. Typically, these plans last for 30 days, starting on the day the patient is released to go home. The patient is connected with a healthcare provider who offers the essential support they need to stay on track and properly recover. Healthcare professionals who can support patients in their TCM include:

  • Physicians
  • Certified nurse-midwives
  • Clinical nurse specialists
  • Nurse practitioners
  • Physician assistants

What Is Included in Transitional Care Management?

Ultimately, that is between you and the patient. Patient needs vary based on the procedure they had done and their personality and lifestyle. For example, someone recovering from gastric bypass surgery might need to check in through your patient portal multiple times a day to ensure they aren’t struggling with their liquid diet while a patient who had knee surgery might need an in-person visit to help them with some simple exercises that promote healing.

TCM services fall into one of three broad categories:

  • Interactive online contact
  • Non-face-to-face services
  • In-person visits

Ultimately, helping patients transition between inpatient and outpatient care helps them achieve better results, boosting your image and bottom line. Sequence Health offers patient engagement solutions that support transitional care management. Contact them today to learn more.

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