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  1. Boston-Fleischhauer, Carol JD, MS, RN
  2. Rose, Robert MS, RN, NEA-BC
  3. Hartwig, Laurie MPA/HCA, BSN, FN, NEA-BC


As healthcare systems continue to design care models responsive to payment changes and the assumption of clinical and financial risk, the need exists for a comprehensive approach to address cross-continuum care transitions. This article will highlight key learnings from the Nurse Executive Center's research on achieving care continuity. The business case for developing a cross-continuum care transition strategy will be discussed, as well as systemic enablers for the achievement of seamless care. A case study example of 1 system's solution for supporting the multiple comorbid patient population as part of its cross-continuum care transition strategy will be examined.