Care Transition Clinic successfully drives down hospital readmission rates

Lowering hospital readmission rates is a top priority at UChicago Medicine. Unfortunately, some patients end up back at the hospital because they have few other care options than to return to the Emergency Department for help. The commitment to reduce healthcare disparities was one of the driving forces behind the development of the Care Transition Clinic (CTC). Many people – particularly patients from low-income communities and communities of color – visit hospitals because they do not have access to a primary care provider. For patients with underlying conditions – such as sickle cell, which mainly affects Black Americans – the likelihood of going to the hospital (and returning) is even higher.

UChicago Medicine is committed to providing the best quality care for patients who come from diverse backgrounds and have wide ranging healthcare needs. The emergency room often isn’t the best place for holistic care to be delivered – and it certainly is not the place to receive preventative healthcare. That’s where the CTC comes in. Thanks to a partnership between the emergency department and CTC, patients with underlying conditions like sickle cell who come to the emergency room with non-emergencies are referred over to CTC to get the care they need.

Once at CTC, we provide these patients with more holistic, targeted, and extended treatment to get them well enough to go home instead of being admitted to the hospital. We also connect them with their primary hematologist for continuity care. This program has been hugely beneficial especially for patients with sickle cell, and it’s also had a marked impact on hospital readmission rates as a whole. From early 2022 to mid-2022, readmission rates dropped by 30%, a positive trend that’s been sustained. Less patients in the hospital is good for everyone: patients, providers, and the system as a whole.