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141. PS Grantee | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/index.html?page=5
     January 01, 2024 - Grant Number: K08 HS 022916 Topic(s): Discharge Planning, Older Adults Publication Date: June 2019

142. Tools To Improve Diagnostic Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/tools/index.html
     June 01, 2025 - Engage patients and families in discharge planning throughout the hospital stay.

143. Tool 12: Cross Continuum Collaboration Tool (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool12_collaboration.docx
     June 02, 2025 - Tool 12: Cross Continuum Collaboration Tool Tool 12: Cross-continuum collaboration tool Purpose This tool helps teams develop specific effective and timely linkages to services with cross-continuum clinical, behavioral, and social services providers. Description Hospital readmission reduction teams need to identify…

144. AHRQ Resources Help Maine Telehealth Network Improve Care in Remote Areas | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/case-studies/cp30506.html
     October 01, 2014 - In addition, the network helps provide social services such as discharge planning.

145. Pfengagement-Material-Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/pfengagement-material-guide.docx
     May 01, 2017 - Be sure to facilitate discussion around use of patient and family advisors and IDEAL discharge planning

146. Appendix A: References and Available Abstracts | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/shuttered/acfselection/appendixa.html
     July 01, 2018 - coordination and liaison; (6) the characteristics of injuries; (7) the importance of protocols for patient … discharge and hospital staffing; and (8) requirements for interpreter services.

147. 3. What Are the Best Practices in Pressure Ulcer Prevention that We Want to Use? (continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu3a.html
     October 01, 2014 - Preventing Pressure Ulcers in Hospitals 3. What Are the Best Practices in Pressure Ulcer Prevention that We Want to Use? (continued) Previous Page Next Page Table of Contents Preventing Pressure Ulcers in Hospitals Overview Key Subject Area Index 1. Are we ready for this change? 2. How will …

148. 3. What Are the Best Practices in Pressure Ulcer Prevention that We Want to Use? (continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/resource/pressureulcer/tool/pu3a.html
     October 01, 2014 - Preventing Pressure Ulcers in Hospitals 3. What Are the Best Practices in Pressure Ulcer Prevention that We Want to Use? (continued) Previous Page Next Page Table of Contents Preventing Pressure Ulcers in Hospitals Overview Key Subject Area Index 1. Are we ready for this change? 2. How will …

149. Patient and Family Engagement for Perinatal Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/pf-engagement-slides.html
     July 01, 2023 - Involving patients and families in discharge planning and plans for safe care at home.

150. Tool 6 (continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/redtool-other.html
     March 01, 2013 - Re-Engineered Discharge (RED) Toolkit Tool 6 (continued) Previous Page   Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures the "30-Day All Cause Rehospitalization Rate" on t…

151. Tool 6 (continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool-other.html
     March 01, 2013 - Re-Engineered Discharge (RED) Toolkit Tool 6 (continued) Previous Page   Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures the "30-Day All Cause Rehospitalization Rate" on t…

152. SNAC Member: Mamatha S. Pancholi, M.S. | Agency for Healthcare Research and Quality
     www.ahrq.gov/cpi/about/nac/snac-pancholi.html
     December 01, 2021 - SNAC Member: Mamatha S. Pancholi, M.S. Chief Data Officer and Senior Advisor to the Director Office of the Director Agency for Healthcare Research and Quality Mamatha S. Pancholi, M.S., joined the Agency for Healthcare Research and Quality (AHRQ) in 1993 and has served in several capacities during her tenur…

153. Final Progress Report: Crossing an Invisible Quality Chasm: From NICU to Ambulatory Care (pdf file)
     www.ahrq.gov/sites/default/files/2024-12/moyer-report.pdf
     January 01, 2024 - Patient discharged from NICU 3 or 2 A) Conduct weekly discharge planning rounds (NICU 2 only) B)

154. Documentation of Mandated Discharge Summary Components in Transitions from Acute to Subacute Care (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Kind_31.pdf
     March 31, 2008 - discharge summary’s pivotal communication role in care transitions, even a small frequency of omitted patient … discharge condition information is a concern and may affect patient safety. … discharge summaries included in this analysis. … discharge summaries. … discharge condition information is a concern and may influence patient safety.

155. Designing & Delivering Whole-Person Transitional Care The Hospital Guide to Reducing Medicaid Readmissions Webinar 5
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/aspire_webinar5/aspire_webinar5.pptx
     June 02, 2025 - Designing & Delivering Whole-Person Transitional Care The Hospital Guide to Reducing Medicaid Readmissions Webinar 5 Designing & Delivering Whole-Person Transitional Care The Hospital Guide to Reducing Medicaid Readmissions Webinar 5:Reach Out to Collaborate with Partners Across Settings Agenda Describe the impo…

156. Final Progress Report: Distance Management of High-Risk Obstetrical Patients (pdf file)
     www.ahrq.gov/sites/default/files/2024-07/ferguson2-report.pdf
     January 01, 2024 - Final Progress Report: Distance Management of High-Risk Obstetrical Patients Project Title: Distance Management of High-Risk Obstetrical Patients Candice Ferguson, MSPH Woman’s Hospital, BR Project Director Stephanie Anderson, BS, CPA Woman’s Hospital, BR Investigator Kim Duplechain…

157. Pre-intervention Assessment: Adapting and Implementing Patient Safety Practices in Ambulatory Care (xls file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/safetransitions/hret-preinterventionasst.xlsx
     June 02, 2025 - Pre-intervention Assessment: Adapting and Implementing Patient Safety Practices in Ambulatory Care Introduction Pre-Intervention Assessment Purpose The purpose for this self-assessment is to: -Highlight current efforts to promote safe transitions of care and engage patients; -Identify gaps or opportunities for…

158. Appendix, Develop a Flowchart of Your Current Medication Reconciliation Process | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/match/appendix/app-5.html
     July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation Appendix, Develop a Flowchart of Your Current Medication Reconciliation Process Previous Page Next Page Table of Contents Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Rec…

159. Appendix, Develop a Flowchart of Your Current Medication Reconciliation Process | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/match/appendix/app-5.html
     July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation Appendix, Develop a Flowchart of Your Current Medication Reconciliation Process Previous Page Next Page Table of Contents Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Rec…

160. Tool 5: How To Conduct a Postdischarge Followup Phone Call | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/redtool5.html
     March 01, 2025 - Re-Engineered Discharge (RED) Toolkit Tool 5: How To Conduct a Postdischarge Followup Phone Call Previous Page Next Page Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures th…