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Project ACHIEVE to Develop Tools to Facilitate Care Transitions

Essential hospitals serve diverse patient populations, including individuals with complex conditions, low health literacy, and socioeconomic barriers to care. Smooth transitions between and out of health care sites are key to ensuring a positive patient experience.

Project ACHIEVE, a collaborative research project funded by the Patient-Centered Outcomes Research Institute, aims to evaluate the effectiveness of efforts to improve care transitions.

Launched in 2014, Project ACHIEVE involves researchers, providers, patients, and caregivers from leading health care organizations around the country. To review care transitions, the project used:

  • focus groups;
  • key informant interviews with patients, caregivers, and providers;
  • a provider survey;
  • site visits; and
  • contextual analysis of all collected data.

The assessment will lead to the development of recommendations and best practices for patient-centered care transitions, as well as guidance for disseminating these practices across the United States.

Essential Hospitals Institute — the research and quality arm of America’s Essential Hospitals — partnered with the University of Kentucky to help develop this research project. With extensive research experience involving essential hospitals and the vulnerable populations they serve, the Institute offered insight on the participant recruitment and dissemination processes.

Researchers presented preliminary findings in an October webinar from the Institute: Improving Care Transitions: Findings From Project ACHIEVE. Project ACHIEVE’s final year will focus on disseminating and implementing best practices for care transitions.

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About the Author

Madeline White is a research assistant at America's Essential Hospitals.