Background Efforts to improve care transitions require coordination across the healthcare
continuum and interventions that enhance communication between acute and community …

Objectives Older adults are often transferred from hospitals to skilled nursing facilities
(SNFs) for post-acute care. Patients may be at risk for adverse outcomes after SNF …

Background Despite growing emphasis on transitional care to reduce costs and improve
quality, few studies have examined transitional care improvements in socioeconomically …

Purpose Transitional care is an emerging model of health care designed to decrease
preventable adverse events and associated utilization of health care through temporary …

This study explored the potential to improve clinical outcomes in patients at risk of moving to
the top segment of the cost acuity pyramid. This randomized controlled trial evaluated the …

Elderly, chronically ill people experience frequent changes in health status that require
transitions among health care providers and settings. This issue brief describes two projects …

Background: The Affordable Care Act of 2010 set forth payment models that provided $10
billion to incent the health care system in developing innovative programs that target reform …

Under the Affordable Care Act of 2010, a variety of transitional care programs and services
have been established to improve quality and reduce costs. These programs help …

Care transitions between settings are a well-known cause of medical errors. A key
component of transition is information exchange, especially in long-term care (LTC) …

Introduction Programs that seek to avoid emergency department (ED) visits from patients
residing in long-term care facilities are increasing. We sought to identify existing programs …