Journal of General Internal Medicine

, Volume 29, Issue 6, pp 878–884 | Cite as

Is Implementation of the Care Transitions Intervention Associated with Cost Avoidance After Hospital Discharge?

  • Rebekah Gardner
  • Qijuan Li
  • Rosa R. Baier
  • Kristen Butterfield
  • Eric A. Coleman
  • Stefan GravensteinEmail author
Original Research



Poorly-executed transitions out of the hospital contribute significant costs to the healthcare system. Several evidence-based interventions can reduce post-discharge utilization.


To evaluate the cost avoidance associated with implementation of the Care Transitions Intervention (CTI).


A quasi-experimental cohort study using consecutive convenience sampling.


Fee-for-service Medicare beneficiaries hospitalized from 1 January 2009 to 31 May 2011 in six Rhode Island hospitals.


The CTI is a patient-centered coaching intervention to empower individuals to better manage their health. It begins in-hospital and continues for 30 days, including one home visit and one to two phone calls.


We examined post-discharge total utilization and costs for patients who received coaching (intervention group), who declined or were lost to follow-up (internal control group), and who were eligible, but not approached (external control group), using propensity score matching to control for baseline differences.


Compared to matched internal controls (N = 321), the intervention group had significantly lower utilization in the 6 months after discharge and lower mean total health care costs ($14,729 vs. $18,779, P = 0.03). The cost avoided per patient receiving the intervention was $3,752, compared to internal controls. Results for the external control group were similar. Shifting of costs to other utilization types was not observed.


This analysis demonstrates that the CTI generates meaningful cost avoidance for at least 6 months post-hospitalization, and also provides useful metrics to evaluate the impact and cost avoidance of hospital readmission reduction programs.


care transitions cost avoidance hospital readmissions Medicare 




The corresponding author affirms that he has listed everyone who contributed significantly to the work. The authors thank the six hospitals where we recruited subjects for the CTI intervention from 2009 to 2011, as well as the other providers and stakeholders who collaborate with Healthcentric Advisors on our ongoing Medicare-funded Safe Transitions Project. We also thank the project team and leadership. Through community collaboration, the Safe Transitions Project aims to transform the Rhode Island healthcare system into one in which discharged patients and their caregivers understand their conditions and medications, know who to contact with questions, and are supported by healthcare professionals who have access to the right information, at the right time. This is our vision statement.


This study was funded by Contract Number HHSM-500-2008-RI, titled “Utilization and Quality Control Peer Review for the State of Rhode Island,” sponsored by the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. Li is supported by the National Institute on Aging (Grant Number 2 T32 AG023482-08A1). Coleman is supported by the John A. Hartford Foundation (Grant Number 2012–0047).

Prior Presentations

This work was presented in a poster session at the Academy Health Annual Research Meeting in Baltimore, MD on 24 June 2013 and as an oral abstract at the Gerontological Society of America's Annual Scientific Meeting in New Orleans, LA on 20 November 2013.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2014_2814_MOESM1_ESM.pdf (368 kb)
ESM 1 (PDF 367 kb)


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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Rebekah Gardner
    • 1
    • 2
  • Qijuan Li
    • 3
  • Rosa R. Baier
    • 1
    • 3
  • Kristen Butterfield
    • 1
  • Eric A. Coleman
    • 4
  • Stefan Gravenstein
    • 1
    • 2
    • 3
    • 5
    • 6
    Email author
  1. 1.Healthcentric AdvisorsProvidenceUSA
  2. 2.Alpert Medical School of Brown UniversityProvidenceUSA
  3. 3.School of Public HealthBrown UniversityProvidenceUSA
  4. 4.University of Colorado Anschutz CampusAuroraUSA
  5. 5.Case Western Reserve UniversityClevelandUSA
  6. 6.University Hospitals--Case Medical CenterClevelandUSA

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