The role of the Programa Melhor em Casa in transitional care: Performance, value, and sustainability

Abstract

Population aging, rising chronic conditions, and the transition of care models have imposed significant challenges for health systems, requiring care reorganization focused on continuity, comprehensiveness, and sustainability. In this context, the Programa Melhor em Casa (PMeC) emerges as a central strategy in home care and care transition within the Health Care Network of the Unified Health System (SUS). This quantitative study, combined with a narrative literature review, analyzed production data from the PMeC between 2019 and 2023, investigating patient profiles, care flows, and clinical outcomes. A total of 515,624 assessments with consolidated outcomes were recorded. Discharges to Primary Health Care accounted for 62.5% of cases, and deaths totaled 14.3%, reflecting the service’s complexity. Referrals for hospitalization (6.4%) and emergency care (4.5%) serve as indirect indicators (proxies), suggesting the program could contribute to safe dehospitalization without proving direct clinical effectiveness. The findings suggest that the PMeC may offer pathways for care reorganization in the SUS, indicating that equity criteria should guide the debate on healthcare savings.