August 7, 2019

Center to Advance Palliative Care (CAPC)

Center to Advance Palliative Care (CAPC). [Web site]. http://www.capc.org/ . Updated 2014. Accessed July 29, 2014. The Center to Advance Palliative Care (CAPC) provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings.
Center to Advance Palliative Care (CAPC). [Web site]. http://www.capc.org/ . Updated 2014. Accessed July 29, 2014. The Center to Advance Palliative Care (CAPC) provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings.
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http://www.capc.org/

August 7, 2019

Hospitalists as emerging leaders in patient safety: lessons learned and future directions

OBJECTIVE To examine the results of a multi-institution, hospitalist-centered consortium designed to disseminate knowledge of best practices relevant to patient safety and to facilitate institutional innovation around such practices. METHODS The Hospitalists as Emerging Leaders in Patient Safety (HELPS) consortium consisted of a hospitalist lead and a patient safety representative […]
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OBJECTIVE To examine the results of a multi-institution, hospitalist-centered consortium designed to disseminate knowledge of best practices relevant to patient safety and to facilitate institutional innovation around such practices. METHODS The Hospitalists as Emerging Leaders in Patient Safety (HELPS) consortium consisted of a hospitalist lead and a patient safety representative from each of 9 health care systems in southeastern Michigan. The consortium's aim was to provide rapid dissemination of best practices in patient safety through regular group meetings and to facilitate implementation and analysis of hospitalist-led patient safety initiatives. Key safety targets included prevention of device-related infections, creating a culture of safety, care transitions, medication safety, fall prevention, perioperative care, intensive care unit safety, and end-of-life care. Participating institutions were free to implement any of the best practices and had access to the expertise of the HELPS coordinating site. Surveys were used to assess knowledge dissemination among participants. RESULTS Participating institutions described their patient safety initiative and identified several key barriers and facilitators encountered during implementation. Common themes emerged among both barriers and facilitators. In postmeeting surveys to measure dissemination, consortium participants answered a mean of 84.2% (SD = 19.2) of the questions correctly. CONCLUSIONS The HELPS consortium successfully disseminated knowledge regarding best practices and identified common barriers and facilitators faced by hospitalists and institutions attempting to improve safety. The next step is to transform the consortium into a robust quality collaborative that leverages key facilitators and prospectively addresses barriers to implementing high-impact interventions in a multihospital setting.
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http://journals.lww.com/journalpatientsafety/Abstract/2009/03000/Hospitalists_as_Emerging_Leaders_in_Patient.2.aspx

August 7, 2019

Developing the Tools to Administer a Comprehensive Hospital Discharge Program: The Re-Engineered Discharge (RED) Program

Introduction: The hospital discharge is nonstandardized and marked with poor quality. One in five hospital discharges is complicated by an adverse event (AE) within 30 days, many of which lead to emergency department visits and rehospitalizations. Methods: Using an iterative group process, we developed the principles and components of the […]
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Introduction: The hospital discharge is nonstandardized and marked with poor quality. One in five hospital discharges is complicated by an adverse event (AE) within 30 days, many of which lead to emergency department visits and rehospitalizations. Methods: Using an iterative group process, we developed the principles and components of the ReEngineered Discharge (RED), a set of 11 distinct components designed to prepare patients for discharge. Three tools were created: a training manual used to train discharge nurses to provide the RED; an individualized, patient-friendly “After Hospital Care Plan” (AHCP), a booklet used to prepare patients for discharge; and a workstation to integrate all pertinent discharge information used to electronically create the AHCP. Outcomes: The RED was adopted by the National Quality Forum (NQF) as one of their “Safe Practices.” Among the intervention subjects, 89 percent were provided with an AHCP at discharge; it required approximately 1 hour for the discharge advocate to provide the RED intervention. Implications: Use of the AHCP tool can effectively prepare patients for discharge, as recommended by NQF 2006 Safe Practice number 11. These results have important implications for quality of care at discharge and for lowering costs.
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http://www.ahrq.gov/downloads/pub/advances2/vol3/Advances-Jack_28.pdf

August 7, 2019

Health care transitions: a review of integrated, integrative, and integration concepts

In this article, several views of the terms integration, integrated, and integrative are considered with the hopes that this brief review will help to raise awareness, clarify various uses of these terms, and add to the continuing discussion of integration and how we might improve health care. Models of integrative […]
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In this article, several views of the terms integration, integrated, and integrative are considered with the hopes that this brief review will help to raise awareness, clarify various uses of these terms, and add to the continuing discussion of integration and how we might improve health care. Models of integrative care, views of integration, and samples of different interpretations and definitions are offered.
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http://www.sciencedirect.com/science/article/pii/S0161475409002978

August 7, 2019

Re-engineering the Discharge Process to Reduce Readmissions

It has long been acknowledged that unplanned re-hospitalizations cost the U.S. health care system billions of dollars each year. Researchers at Boston University Medical Center have been working on a project to reduce readmission rates by improving and standardizing the hospital discharge process. Thanks in part to the intersection of […]
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It has long been acknowledged that unplanned re-hospitalizations cost the U.S. health care system billions of dollars each year. Researchers at Boston University Medical Center have been working on a project to reduce readmission rates by improving and standardizing the hospital discharge process. Thanks in part to the intersection of national policy with their clinical goals, the researchers’ work has begun to attract widespread interest. The initiative, called Project Re-Engineered Discharge (RED), is still in a randomized control trial phase, but initial results show that using the RED protocol may significantly reduce readmission rates, says Brian Jack, MD, the project’s principal investigator. Jack is an associate professor and vice chair for academic affairs in the department of family medicine at Boston University School of Medicine and Boston Medical Center.
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http://www.pressganey.com/newslanding/10-06-22/Re-engineering_the_discharge_process_to_reduce_readmissions.aspx

August 7, 2019

Why Not the Best? A Health Care Quality Improvement Resource

The Commonwealth Fund. Why Not The Best? Quality improvement resources for health care professionals. [Web site]. Http://whynotthebest.org/ Updated 2014. Accessed July 29, 2014. WhyNotTheBest.org was created and is maintained by The Commonwealth Fund, a private foundation working toward a high performance health system. It is a free resource for health […]
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The Commonwealth Fund. Why Not The Best? Quality improvement resources for health care professionals. [Web site]. Http://whynotthebest.org/ Updated 2014. Accessed July 29, 2014. WhyNotTheBest.org was created and is maintained by The Commonwealth Fund, a private foundation working toward a high performance health system. It is a free resource for health care professionals interested in tracking performance on various measures of health care quality. It enables organizations to compare their performance against that of peer organizations, against a range of benchmarks, and over time. Case studies and improvement tools spotlight successful improvement strategies of the nation’s top performers. A regional map shows performance at the county, HRR, state, and national levels. WhyNotTheBest.org is recognized as a “Health Data All Star.” Health Data All Stars is a directory of 50 prominent domestic resources for health data at the federal, state and local levels housed on the Health Data Consortium’s website. To compile the directory, consortium leaders spoke with leading health researchers, government officials, entrepreneurs, advocates and others to identify the health data resources that matter most.
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http://whynotthebest.org/

August 7, 2019

Transitions of elders between long-term care and hospitals

Elderly long-term care recipients who require acute hospitalizations must navigate a fragmented system with poor “handoffs,” often resulting in negative outcomes. This article makes the case that reducing preventable hospitalizations and improving transitions to and from hospitals will enhance health care quality and outcomes among these elders. Immediate action targeting […]
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Elderly long-term care recipients who require acute hospitalizations must navigate a fragmented system with poor "handoffs," often resulting in negative outcomes. This article makes the case that reducing preventable hospitalizations and improving transitions to and from hospitals will enhance health care quality and outcomes among these elders. Immediate action targeting diffusion of evidence-based care is recommended to decrease avoidable rehospitalizations and achieve cost savings. Policy changes are needed to address barriers to high-quality transitional care, including deficits in health professionals' and caregivers' knowledge and resources, regulatory obstacles, and inadequate financial incentives and clinical information systems.
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http://ppn.sagepub.com/content/10/3/187.abstract

August 7, 2019

Maryland Promotes Patient Centered Medical Home Pilot

Maryland Health Care Commission News Release: Legislation creating a three-year Patient Centered Medical Home Pilot program passed the General Assembly earlier this year and was championed by Lieutenant Governor Anthony G. Brown. The legislation grew out of the Maryland Health Quality and Cost Council, established by Governor Martin O’Malley and […]
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Maryland Health Care Commission News Release: Legislation creating a three-year Patient Centered Medical Home Pilot program passed the General Assembly earlier this year and was championed by Lieutenant Governor Anthony G. Brown. The legislation grew out of the Maryland Health Quality and Cost Council, established by Governor Martin O'Malley and chaired by Lt. Governor Brown and Maryland Department of Health and Mental Hygiene Secretary John M. Colmers. "Our newly established Patient Centered Medical Home program will allow Maryland to move forward with health care reform, improve the quality of care, and reduce costs by offering primary care providers responsible incentives to spend more time with patients, coordinate care, and promote prevention and wellness," said Lt. Governor Brown. "We are incredibly grateful that Dr. Grundy has joined our efforts and is sharing his expertise with our primary care providers."
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http://dhmh.maryland.gov/publicrelations/pr/pdfs/pr062910.pdf

August 7, 2019

Bridging troubled waters: family caregivers, transitions, and long-term care

Families are the bedrock of long-term care, but policymakers have traditionally considered them “informal” caregivers, as they are not part of the formal paid caregiving workforce. As chronic and long-term care systems have become more complex and as more demanding tasks have been shifted to families, this view is no […]
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Families are the bedrock of long-term care, but policymakers have traditionally considered them "informal" caregivers, as they are not part of the formal paid caregiving workforce. As chronic and long-term care systems have become more complex and as more demanding tasks have been shifted to families, this view is no longer sustainable. The care transition process offers a critical opportunity to treat family caregivers as important care partners. Enhancing their involvement, training, and support will contribute to reducing unnecessary rehospitalizations and improving patient outcomes. The contributions and experiences of family caregivers should be considered in gathering information to shape policies and practice; training health care professionals; developing programs; and reforming financing.
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http://content.healthaffairs.org/content/29/1/116.abstract

August 7, 2019

The Dartmouth Atlas of Health Care

The Trustees of Dartmouth College. The Dartmouth Atlas of Health Care. [Web site]. http://www.dartmouthatlas.org/ . 2014. Accessed July 25, 2014. Understanding of the Efficiency and Effectiveness of the Health Care System. For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed […]
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The Trustees of Dartmouth College. The Dartmouth Atlas of Health Care. [Web site]. http://www.dartmouthatlas.org/ . 2014. Accessed July 25, 2014. Understanding of the Efficiency and Effectiveness of the Health Care System. For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policymakers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for many of the ongoing efforts to improve health and health systems across America.
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http://www.dartmouthatlas.org/

August 7, 2019

The Effect of the Program of All-Inclusive care for the Elderly (PACE) on Quality: Final Report

The Balanced Budget Act (BBA) of 1997 authorized Medicare coverage of the Program of All-Inclusive Care for the Elderly (PACE) and established PACE as a state plan option under Medicaid. It authorized a demonstration of for-profit PACE sites, and mandated that the U.S. Secretary of Health and Human Services (HHS) […]
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The Balanced Budget Act (BBA) of 1997 authorized Medicare coverage of the Program of All-Inclusive Care for the Elderly (PACE) and established PACE as a state plan option under Medicaid. It authorized a demonstration of for-profit PACE sites, and mandated that the U.S. Secretary of Health and Human Services (HHS) conduct a study of the quality and cost of providing PACE program services under the amendments of the BBA of 1997. This report assesses the quality of PACE care.
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http://www.cms.gov/reports/downloads/Beauchamp_2008.pdf

August 7, 2019

Top EHR challenges in light of the stimulus. Enabling effective interdisciplinary, intradisciplinary and cross-setting communication

US healthcare is undergoing a transformation. The economic stimulus plan is intended to transform healthcare through health IT. The government has defined “meaningful use” of health IT. Healthcare is a team activity, and as such presents a challenge to the concept of meaningful use. While encoding clinical data into a […]
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US healthcare is undergoing a transformation. The economic stimulus plan is intended to transform healthcare through health IT. The government has defined "meaningful use" of health IT. Healthcare is a team activity, and as such presents a challenge to the concept of meaningful use. While encoding clinical data into a computer is a positive step, it is not enough. A continuity-of-care record is needed to document and measure care; support clinical care; and coordinate care with public health agencies. This paper examines current research to assist decisionmakers moving forward. To realize the promise, integration across all clinical disciplines is critical. There are many challenges. These include: the threat of information overload, both at the transitions of care and between disciplines; the need to provide for data-sharing between clinical and public health agencies, an important component in both local community and national health issues; how to use health IT to improve the delivery of healthcare, especially with unintended outcomes of any change in healthcare and paper persistence; and addressing different views of "meaningful" for different uses and users of health IT. All of these challenges need to be considered for wise installation of health IT. In addition, attention must be paid to weaknesses in the current healthcare system to prevent codifying them in health IT.
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http://www.himss.org/content/files/jhim/24-1/JHIM_Boyd.pdf

August 7, 2019

The New York Academy of Medicine: The Promise of Care Coordination

A major new report finds that care coordination programs can reduce hospitalizations and Medicare costs and improve the quality of care for chronically ill older adults—provided the programs: promote direct engagement of teams of primary care physicians, nurses and social workers; create close communication among all providers involved in a […]
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A major new report finds that care coordination programs can reduce hospitalizations and Medicare costs and improve the quality of care for chronically ill older adults—provided the programs: promote direct engagement of teams of primary care physicians, nurses and social workers; create close communication among all providers involved in a patient’s care; and empower patients to help manage their own care. Released at the 2009 Annual Conference of the American Society on Aging and the National Council on Aging, “The Promise of Care Coordination: Models that Decrease Hospitalizations and Improve Outcomes for Medicare Beneficiaries with Chronic Illnesses” can help policy-makers craft national health care reforms that will better serve older adults and their caregivers.
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http://www.nyam.org/news/press-releases/2009/3208.html

August 7, 2019

Reshaping the healthcare delivery network

Challenges that most healthcare organizations face today include: falling bond ratings and the scarcity of capital resources; delivery of consistently high-quality care despite budget cuts; changes in payer mix due to unemployed patients, the uninsured, early retirees, and an increase in patients postponing care; increasing competition from nontraditional competitors; the […]
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Challenges that most healthcare organizations face today include: falling bond ratings and the scarcity of capital resources; delivery of consistently high-quality care despite budget cuts; changes in payer mix due to unemployed patients, the uninsured, early retirees, and an increase in patients postponing care; increasing competition from nontraditional competitors; the need to prepare for healthcare reform without knowing what form it will take.
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http://www.readperiodicals.com/201001/1975387881.html

August 7, 2019

Health Information in Multiple Languages

Medline Plus. Health Information in Multiple Languages. [Web site]. http://www.nlm.nih.gov/medlineplus/languages/languages.html. Updated July 23, 2014. Accessed July 25, 2014. MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health, has a multilingual feature that provides access to high quality health information for patients in multiple […]
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Medline Plus. Health Information in Multiple Languages. [Web site]. http://www.nlm.nih.gov/medlineplus/languages/languages.html. Updated July 23, 2014. Accessed July 25, 2014. MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health, has a multilingual feature that provides access to high quality health information for patients in multiple languages. This collection contains more than 2,500 links to nearly 250 health topics.
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http://www.nlm.nih.gov/medlineplus/languages/languages.html

August 7, 2019

Acute clinical care and care coordination for traumatic brain injury within Department of Defense

The nature of current combat situations that U.S. military forces encounter and the use of unconventional weaponry have dramatically increased service personnel’s risks of sustaining a traumatic brain injury (TBI). Although the true incidence and prevalence of combat-related TBI are unknown, service personnel returning from deployment have reported rates of […]
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The nature of current combat situations that U.S. military forces encounter and the use of unconventional weaponry have dramatically increased service personnel's risks of sustaining a traumatic brain injury (TBI). Although the true incidence and prevalence of combat-related TBI are unknown, service personnel returning from deployment have reported rates of concussion between 10% and 20%. The Department of Defense has recently released statistics on TBI dating back to before the wars in Iraq and Afghanistan to better elucidate the impact and burden of TBI on America's warriors and veterans. Patients with severe TBI move through a well-established trauma system of care, beginning with triage of initial injury by first-responders in the war zone to acute care to rehabilitation and then returning home and to the community. Mild and moderate TBIs may pose different clinical challenges, especially when initially undetected or if treatment is delayed because more serious injuries are present. To ensure identification and prompt treatment of mild and moderate TBI, the U.S. Congress has mandated that military and Department of Veterans Affairs hospitals screen all service personnel returning from combat. Military health professionals must evaluate them for concussion and then treat the physical, emotional, and cognitive problems that may surface. A new approach to health management and care coordination is needed that will allow medical transitions between networks of care to become more centralized and allow for optimal recovery at all severity levels. This article summarizes the care systems available for the acute management of TBI from point of injury to stateside military treatment facilities. We describe TBI assessment, treatment, and overall coordination of care, including innovative clinical initiatives now used.
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http://www.rehab.research.va.gov/jour/09/46/6/pdf/jaffee.pdf

August 7, 2019

Transitions of Care in the Long-Term Care Continuum: Practice Guideline

This clinical practice guideline (CPG) has been developed under a project conducted by the American Medical Directors Association (AMDA), the national professional organization representing medical directors, attending physicians, and other practitioners who care for patients in the long-term care setting. This is one of a number of guidelines undertaken as […]
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This clinical practice guideline (CPG) has been developed under a project conducted by the American Medical Directors Association (AMDA), the national professional organization representing medical directors, attending physicians, and other practitioners who care for patients in the long-term care setting. This is one of a number of guidelines undertaken as part of the association’s mission to improve the quality of care delivered to patients in these settings. Original guidelines are developed by interdisciplinary workgroups, using a process that combines evidence and consensus-based approaches. Workgroups include practitioners and others involved in patient care in long-term care facilities. Beginning with a general guideline developed by an agency, association, or organization such as the Agency for Healthcare Research and Quality (AHRQ), pertinent articles and information, and a draft outline, each group works to make a concise, usable guideline that is tailored to the long-term care setting. Because scientific research in the long-term care population is limited, many recommendations are based on the expert opinion of practitioners in the field. A bibliography is provided for individuals who desire more detailed information. Guideline revisions are completed under the direction of the Clinical Practice Guideline Steering Committee. The committee incorporates information published in peer-reviewed journals after the original guidelines appeared as well as comments and recommendations not only from experts in the field addressed by the guideline but also from “hands-on” long-term care practitioners and staff.
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http://www.amda.com/tools/clinical/toccpg.pdf

August 7, 2019

Advance Care Planning: Preferences for Care at the End-of-Life

Agency for Healthcare Research and Quality. Advance Care Planning: Preferences for Care at the End-of-Life. http://www.ahrq.gov/research/findings/factsheets/aging/endliferia/endria.pdf. Published March 2003. Accessed July 25, 2014. Research can help physicians and other health care professionals guide patient decision making for care at the end of life. Findings resulting from research funded by the […]
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Agency for Healthcare Research and Quality. Advance Care Planning: Preferences for Care at the End-of-Life. http://www.ahrq.gov/research/findings/factsheets/aging/endliferia/endria.pdf. Published March 2003. Accessed July 25, 2014. Research can help physicians and other health care professionals guide patient decision making for care at the end of life. Findings resulting from research funded by the Agency for Healthcare Research and Quality are discussed.
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http://www.ahrq.gov/research/endliferia/endria.pdf

August 7, 2019

Caregiver perspectives on transitions to assisted living and memory care

This study describes family caregivers’ experiences moving relatives with Alzheimer’s disease or related disorders (ADRD) from their homes to assisted living facilities (ALFs) and subsequently to memory care units (MCUs). We also examined how these experiences differed between caregiver dyad types, such as adult children caring for parents. In-depth interviews […]
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This study describes family caregivers' experiences moving relatives with Alzheimer's disease or related disorders (ADRD) from their homes to assisted living facilities (ALFs) and subsequently to memory care units (MCUs). We also examined how these experiences differed between caregiver dyad types, such as adult children caring for parents. In-depth interviews with 15 caregivers were transcribed verbatim. Grounded theory identified themes. Constant comparative analysis compared experiences of caregiver dyads. Most caregivers recognized the likely need for future specialized care at the time of the move to the ALF, but did not recall receiving information about transfer policies. The ALF move was harder for spouses, the MCU move for adult children. Assisted living facilities can improve support for caregivers facing a relative's MCU transition through education about advantages of MCU placement and information about transfer policies. Support needs during transitions may differ between adult children and spouses.
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http://aja.sagepub.com/content/25/3/255.abstract

August 7, 2019

Improving Care Transitions: A Key Component of Health Care Reform

Blog by Eric Coleman and Amy Berman The Community-Based Care Transitions Program, a provision of the newly enacted Patient Protection and Affordable Care Act (Section 3026 of HR 3590), provides $500 million to collaborative partnerships between hospitals and community-based organizations designed to meet the goal of implementing evidence-based care transitions […]
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Blog by Eric Coleman and Amy Berman The Community-Based Care Transitions Program, a provision of the newly enacted Patient Protection and Affordable Care Act (Section 3026 of HR 3590), provides $500 million to collaborative partnerships between hospitals and community-based organizations designed to meet the goal of implementing evidence-based care transitions services for Medicare beneficiaries at high risk for hospital readmission.
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http://healthaffairs.org/blog/2010/04/29/improving-care-transitions-a-key-component-of-health-reform/