title: Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals.
abstract: Article-at-a-Glance Background: Care transitions across health care settings are common and can result in adverse outcomes for older adults. Few studies have examined health care professionals' perspectives on important process measures or pay-for-performance (P4P) strategies related to transitional care. A study was conducted to characterize health care professionals' perspectives on (1) successful transitional care of older adults (age 65 years and older), (2) suggestions for improvement, and (3) P4P strategies related to transitional care.
  
  
  METHODS
  In a qualitative study, one-hour semistructured in-depth interviews were conducted in an acute care hospital, a skilled nursing facility, two community-based primary care practices, and one home health care agency with 20 health care professionals (18 physicians and 2 home health care administrators) with direct experience in care transitions of older adults and who were likely to be affected by P4P strategies.
  
  
  RESULTS
  Findings were organized into three thematic domains: (1) components and markers of effective transitional care, (2) difficulties in design and implementation of P4P strategies, and (3) health care professionals' concerns and unmet needs related to delivering optimal care during transitions. A conceptual framework was developed on the basis of the findings to guide design and implementation of P4P strategies for improving transitional care.
  
  
  CONCLUSIONS
  In characterizing health care professionals' perspectives, specific care processes to target, challenges to address in the design of P4P strategies, and unmet needs to consider regarding education and feedback for health care professionals were described. Future investigations could evaluate whether performance targets, educational interventions, and implementation strategies based on this conceptual framework improve quality of transitional care.
authors.affiliation: Transitional Care Research, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
authors.forename: Alicia I
authors.initials: AI
authors.lastname: Arbaje
authors.forename: Alison R
authors.initials: AR
authors.lastname: Newcomer
authors.forename: Kenric A
authors.initials: KA
authors.lastname: Maynor
authors.forename: Robert L
authors.initials: RL
authors.lastname: Duhaney
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Eubank
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carrese