PCORI Offers $15 Million to Study Effectiveness of Transitional Care Services in Reducing Avoidable Hospital Readmissions, Improving Patient Outcomes

WASHINGTON, DC — The Patient-Centered Outcomes Research Institute (PCORI) today issued a call for comparative effectiveness research proposals to determine which clusters of specific transitional care services achieve the best patient-centered outcomes while lowering rates of unnecessary readmissions to hospitals or other acute care settings.

PCORI will provide up to $15 million to support a three-year, comprehensive study of the effectiveness of transitional care services, which encompass a broad range of interventions designed to promote the safe and effective movement of patients across different levels of care and settings, such as from a hospital to a rehabilitation facility or to the patient’s home.

As detailed in the funding announcement, PCORI is specifically interested in understanding which service clusters are most effective for different at-risk subpopulations, such as people with limited caregiver support or limited health coverage, and in different healthcare contexts, such as integrated delivery systems and medical homes. Proposals may be submitted by organizations or consortia of organizations that have the expertise, resources, and experience to answer all the questions of interest.

“Resettling into post-acute care daily living after a hospital stay often can be confusing and even overwhelming for patients and their caregivers, underscoring the need for effective services to ease this transition,” said Steven Clauser, PhD, MPA, Director of PCORI’s Improving Healthcare Systems Program. “Achieving good outcomes depends on transitional care services that are well aligned with patients’ specific needs, which can be influenced by many factors and circumstances that research should take into account.”

Improving transitional care is one of the topics for research funding identified by PCORI’s multi-stakeholder Advisory Panel on Improving Healthcare Systems. The issue is of particular importance because the effectiveness of hospital-to-post-acute transitional care in the United States is suboptimal.

Nearly 20 percent of Medicare beneficiaries are readmitted to a hospital within 30 days of being released, and 90 percent of these readmissions are the result of worsening health after discharge due to preventable factors, according to the Medicare Payment Advisory Commission.

Applicants must submit letters of intent (LOIs) no later than 5 p.m. ET Friday, March 7. The LOIs will be reviewed by PCORI staff and applicants will be notified whether they have been selected to submit a full application by Friday, March 21. More information about this funding opportunity, including criteria and key dates, is available in the Funding Opportunities section of PCORI's website.

PCORI has added new resources to its application process that are designed to help applicants meet all criteria. These include a new rubric designed to guide applicants in developing the required patient and other stakeholder engagement plan and revised budget templates that will enable easier completion and entry into the application system. Applicants can also learn more about the submission process and criteria for this funding opportunity through an informational “town hall” webinar beginning at 1 p.m. ET on Wednesday, Feb. 12.

This funding announcement is one of eight issued today by PCORI, which is seeking to invest up to $206 million in patient-centered comparative effectiveness research through these calls for proposals. It has awarded more than $464 million to support 279 patient-centered research projects to date.