Background Discharge planning is a routine feature of health systems in many countries that
aims to reduce delayed discharge from hospital, and improve the co‐ordination of services …

Although patient centredness is part of providing high-quality health care, little is known
about the effectiveness of care transition interventions that involve patients and their families …

Importance Hospital readmissions are frequent, costly, and sometimes preventable.
Although these issues have been well publicized and incentives to reduce them introduced …

Introduction Transitions of care experiences leave patients vulnerable to adverse outcomes,
including readmissions, worsening symptoms, and reductions in functional status. Aim To …

Background: Despite the well-documented risks to patient safety associated with transitions
from one care setting to another, health care organizations struggle to identify which …

Objectives Post-discharge adverse events (AEs) are common and heralded by new and
worsening symptoms (NWS). We evaluated the effect of electronic health record (EHR) …

ABSTRACT Background Adverse drug events (ADEs) are a frequent cause of injury in
patients. Our aim was to assess whether pharmacist interventions compared with no …

Abstract Background The Centers for Medicare and Medicaid (CMS) established the
Hospital Readmissions Reduction Program (HRRP) to reduce reimbursement payments to …

Background: Social risk screening during inpatient care is required in new CMS regulations,
yet its impact on inpatient care and patient outcomes is unknown. Objectives: To evaluate …

JB and RKH work on contracts to improve care transitions quality and reduce hospital
readmissions funded by the Centers for Medicare and Medicaid services. JB received …