Penn Nursing has announced that the THRIVE: Equity-Focused Transitional Care Model has been designated as an Edge Runner by the American Academy of Nursing. Edge Runners are evidence-based, nurse-designed models that demonstrate significant clinical, financial, community, and policy outcomes with proven sustainability and replicability. Each of these programs highlights nurses’ ingenuity and collaboration in developing new methods to provide care and promote health equity. THRIVE is one of six innovative programs to be given this designation this year.

“Thrives designation as an academy edge runner is a testament to our team’s dedication to transforming healthcare delivery to ensure that it works for the most underserved,” said J. Margo Brooks Carthon, the Tyson Family Endowed Term Chair for Gerontological Research; a professor of nursing in the department of family and community health; associate director of the Center for Health Outcomes and Policy Research; and a fellow of the Leonard Davis Institute of Health Economics.

The THRIVE model is an interdisciplinary, 30-day intervention that includes intensive wrap around services, home care, virtual case management and extended engagement of hospital-based providers following hospitalization. It aims to support Medicaid-insured adults through personalized care, addressing both health and social needs, and ensuring a smooth transition from hospital to home. Nurses are integrated throughout the THRIVE clinical pathway at every stage from nurse case manager referrals during hospitalization, to nurse-led home care, and weekly case management throughout the 30-day intervention.

“The academy is proud to designate these solution-oriented initiatives as Edge Runners,” said academy president Linda D. Scott. “The diverse focus of these models highlights the wide range of services, vital support, and innovative team-based approaches that the nursing profession provides. Each Edge Runner model demonstrates how nurses are pioneers in addressing important healthcare challenges.”

The Edge Runner program leads for each of these innovative models of care will be honored at the 2024 Health Policy Conference, taking place October 31-November 2, 2024, in Washington, DC.

Research contributors to the development and evaluation of THRIVE include Penn Nursing’s Heather Brom, research assistant professor; Pam Cacchione, professor; and Rebecca Clark, assistant professor. Longstanding clinical partners include Penn Medicine associate director of community and diversity Marsha Grantham-Murillo, and Jovan Bennett from Penn Center for Community Health Workers.