The transitionalist: optimizing inpatient-to-outpatient transitions of care.

摘要

I read the recent article on the implementation of a transitional care program (TCP) for patients with heart failure at Baylor Medical Center Garland (BMCG) with great interest. Heart failure is arguably one of the most frustrating disease processes to manage in medicine because of the multitude of factors that may lead to undesirable (and sometimes uncontrollable) outcomes. The enormous cost burden of heart failure to the health care system, especially from rehospitaliza-tions, is well described in the literature.