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  1. digital.ahrq.gov/sites/default/files/docs/citation/k08hs023683-blecker-final-report-2018.pdf
    January 01, 2018 - Scope: Evidence-based therapy for heart failure remains underutilized at hospital discharge, particularly … We compared discharge utilization of an ACE inhibitor or angiotensin receptor blocker (ARB) in the … than patients without a diagnosis of heart failure at discharge (85.3% vs 70.4%, p=0.001). … Changes in discharge location and readmission rates under bundled payment. … Observation units as substitutes for hospitalization or home discharge.
  2. digital.ahrq.gov/national-webinars/role-health-it-improve-care-transitions
    January 01, 2023 - work on smartphone-based applications to improve care coordination, an interactive patient-centered discharge … Identify barriers and facilitators of implementation, adoption, and use of a patient-centered discharge
  3. digital.ahrq.gov/ahrq-funded-projects/nicu-2-home-using-hit-support-parents-nicu-graduates-transitioning-home/annual-summary/2011
    January 01, 2011 - from the NICU to the home, although research indicates that parents feel anxious and unprepared for discharge … communication technologies and digital media content will provide parents with supportive guidance on the discharge … process and post-discharge care; easy access to information and enhanced communication; tools, such … transition from the NICU to home; and links between the NICU, home, and the community pediatrician after discharge
  4. digital.ahrq.gov/ahrq-funded-projects/scalable-digital-communication-intervention-support-older-adults-and-care
    January 01, 2024 - to support care transitions for older adults after surgery has the potential to provide timely post-discharge … Providing patients with timely post-discharge information and interdisciplinary communication can reduce … readmissions, increase adherence to discharge recommendations, and relieve patient and family stress
  5. digital.ahrq.gov/sites/default/files/docs/citation/k08hs024134-smith-final-report-2019.pdf
    January 01, 2019 - the quality of care for cancer patients undergoing major surgery and, reduces the high rate of post-discharge … study is to explore novel strategies, which incorporate patient-centered outcomes and improve post-discharge … that can rapidly identify and appropriately address potentially serious problems experienced post- discharge … The factors her research had identified (e.g., lapses in post-discharge care, geographical barriers, … and poor patient education) suggested the need to develop innovative post-discharge strategies that
  6. digital.ahrq.gov/ahrq-funded-projects/using-health-information-technology-improve-transitions-complex-elderly/annual-summary/2011
    January 01, 2011 - scheduling alerts on the rate of followup office visits with an outpatient physician within 21 days of discharge … monitoring alerts on the rate of appropriate monitoring for selected high-risk medications within 30 days of discharge … information technology-based transitional care intervention on the incidence of ADEs within 45 days after discharge … intervention on the incidence of hospital readmission and emergency department visits within 30 days of discharge
  7. digital.ahrq.gov/2018-year-review/research-summary/decreasing-tobacco-related-healthcare-costs-using-interactive
    January 01, 2018 - automated opt-out Tobacco Dependence Treatment Service (TDTS) interfaced with the hospital’s admission and discharge … provide referrals to community tobacco cessation services at 3, 14, 30, 90, and 180 days after hospital discharge … Those using the TDTS service were 23 percent less likely to be readmitted to the hospital 30 days after discharge
  8. digital.ahrq.gov/technology/secure-messaging
    January 01, 2023 - Portals Interactive digital health tools to engage patients and caregivers in discharge … Interactive digital health tools to engage patients and caregivers in discharge preparation: Implementation … Project Name Interactive Patient-Centered Discharge Toolkit To Promote Self-Management During Transitions
  9. digital.ahrq.gov/principal-investigator/smith-kenneth-j
    January 01, 2023 - Automated communication tools and computer-based medication reconciliation to decrease hospital discharge … Automated communication tools and computer-based medication reconciliation to decrease hospital discharge
  10. digital.ahrq.gov/sites/default/files/docs/citation/r21hs023863-cartmell-final-report-2018.pdf
    January 01, 2018 - service (TDTS) on 30, 90 and 180 day hospital readmissions and healthcare charges within 1-year post-discharge … Results: At 30 days post-discharge, smokers exposed to the TDTS had lower odds of readmission (OR=0.77 … The innovative system interfaces with the hospitals admission and discharge records to identify tobacco … This study compared unplanned readmissions at 30, 90, and 180 days after discharge among adult current … IVR follow-up calls), low exposure defined as responding only to the post-discharge IVR follow-up
  11. digital.ahrq.gov/sites/default/files/docs/page/2006Rosati_052411comp.pdf
    June 05, 2006 - the Transition to Home Health Care Using an Electronic Communication System Available to Physicians, Discharge … Transition to Home Health Care Using an Electronic Communication System Available to Physicians, Discharge … the Transition to Home Health Care Using an Electronic Communication System Available to Physicians, Discharge
  12. digital.ahrq.gov/sites/default/files/docs/citation/r21hs020316-garfield-final-report-2014.pdf
    January 01, 2014 - Passport-2-Home: a self-guiding discharge checklist; 2.) … from the NICU, one day prior to discharge (T-1), and two weeks after discharge (T+14). … Rehospitalization in the First Two Weeks After Discharge From the Neonatal Intensive Care Unit. … Discharge Teaching in the NICU: Are Parents Prepared? … Neonatal intensive care unit discharge preparedness: primary care implications. Clin. Pediatr.
  13. digital.ahrq.gov/principal-investigator/orenstein-evan
    January 01, 2023 - support strategy to increase seasonal influenza vaccination among hospitalized children before inpatient discharge … support strategy to increase seasonal influenza vaccination among hospitalized children before inpatient discharge
  14. digital.ahrq.gov/sites/default/files/docs/medication-without-harm-slides-07242024.pdf
    January 12, 2025 - reduce the prescribing of potentially inappropriate medications to older patients at the time of discharge … Order Set (EPIC) Discharge Order Set (Cerner) 2019–2021 Scale-Up Methods for Scaling Up EQUIPPED … Change in PIM proportion: » Total PIMs / All discharge medications prescribed to patients aged 65+ … Aim Statement Influencing Prescribing Behavior: Three Core Components Clinical Decision Support: Discharge … Order Sets (CPRS) Discharge Order Set (EPIC) Discharge Order Set (Cerner) 2019–2021 Scale-Up Methods
  15. digital.ahrq.gov/ahrq-funded-projects/health-information-technology-and-improving-medication-use/annual-summary/2012
    January 01, 2012 - clinical decision support (CDS), evaluating new processes for medication reconciliation post- hospital discharge … (Achieved) Evaluate the impact of implementing a post-discharge ambulatory medication reconciliation … Project 4: Ambulatory Medication Reconciliation Following Hospital Discharge . … The project team conducted a secondary analysis of the accuracy of medication lists 1 month after discharge … The project team completed a manuscript describing their findings on the impact of the post-discharge
  16. digital.ahrq.gov/ahrq-funded-projects/health-information-technology-and-improving-medication-use
    January 01, 2023 - using clinical-decision support (CDS), evaluating new processes for medication reconciliation post-discharge … Evaluate the impact of implementing a post-discharge ambulatory medication reconciliation intervention … Ambulatory Medication Reconciliation Following Hospital Discharge. … The team found that the accuracy of documented medication regimens 30 days after discharge was around … Lessons learned from implementation of a computerized application for pending tests at hospital discharge
  17. digital.ahrq.gov/ahrq-funded-projects/health-information-technology-and-improving-medication-use/annual-summary/2010
    January 01, 2010 - using clinical decision support (CDS), evaluating new processes for medication reconciliation post-discharge … implementation of electronic prescribing. ( Ongoing ) Evaluate the impact of implementing a post-discharge … Project 4: Ambulatory Medication Reconciliation Following Hospital Discharge. … In 2007, a post-discharge medication reconciliation module was created within the ambulatory EHR to reduce … Project 4: The project team began analyzing the outcomes of using the post-discharge medication reconciliation
  18. digital.ahrq.gov/events/national-web-conference-using-health-it-improve-care-coordination-and-outcomes-patients-complex-needs
    January 01, 2023 - availability of information following care transitions including hospital and emergency department discharge … Objectives: Describe the impact on patient outcomes and hospital readmissions of an EHR-generated “discharge
  19. digital.ahrq.gov/sites/default/files/docs/2010-04-06%20Patient%20Empowerment%20(1).pdf
    January 01, 2010 - Patient Activation Usual Care Transition Intervention IVR‐enhanced Care Transition Intervention Discharge … Condition or Red  Flags Hospital Transition Coach:  ‐Conduct initial hospital visit ‐Prepare for discharge … ‐Introduce IVR, PHR and Intervention Activities  Checklist Discharge Home Follow‐up IVR: ‐ … Initial call 24‐72 hours post discharge ‐Subsequent automated IVR phone calls daily up  to 28 days …  post‐discharge Transition Coach: ‐Follow‐up calls if IVR alerts on Dashboard Role of the Coach
  20. digital.ahrq.gov/ahrq-funded-projects/patient-centered-postoperative-wound-surveillance-using-current-technology
    January 01, 2023 - Assessment Technology: Mobile Phone Population: Adults Current use of telemedicine for post-discharge … Current use of telemedicine for post-discharge surgical care: a systematic review. … Mobile Phone Population: Adults , Surgeon Predictors of surgical site infection after hospital discharge … Predictors of surgical site infection after hospital discharge in patients undergoing major vascular

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