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psnet.ahrq.gov/node/851070/psn-pdf
June 28, 2023 - diagnostic-safety-across-transitions-care-throughout-healthcare-system-current-state-and-call
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
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psnet.ahrq.gov/node/838077/psn-pdf
September 14, 2022 - unexpectedly-long-hospital-stays-indicator-risk-unsafe-care-exploratory-study
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
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psnet.ahrq.gov/node/73318/psn-pdf
May 26, 2021 - transitions-care-consensus-policy-statement-american-college-physicians-society-general
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
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psnet.ahrq.gov/node/74837/psn-pdf
February 16, 2022 - issue/medication-without-harm-whos-third-global-patient-safety-challenge
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
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psnet.ahrq.gov/node/74082/psn-pdf
November 17, 2021 - associations-person-related-environment-related-and-communication-related-factors-medication
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/aspire_webinar3/aspire_webinar3.pptx
December 01, 2014 - Managed Care Organizations (MCOs)
MCOs can assist with:
Identify PCP
Home Nursing
Medication adherence
Discharge … planning from all levels of care
Disease Management
Complex Case Management
Coordination of services
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psnet.ahrq.gov/issue/hospital-readmissions-physician-awareness-and-communication-practices
December 19, 2009 - July 10, 2008
View More
Related Resources
Standardizing hospital discharge … planning at the Mayo Clinic.
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digital.ahrq.gov/sites/default/files/docs/hit-aging-adults-slides-071717.pdf
July 17, 2017 - Planning
Kevin Ponto, Ph.D. … reality visualization
69
Subsequent Research
Crime scene
investigation
Cultural
heritage
Discharge … planning
70
Virtualized Homes
AHRQ R03HS024623 - Home 3D
71
Virtualized Homes
Extends the … Key Observations
Summary
Acknowledgments
Contact Information
Virtualized Homes: Tools for Better Discharge … Planning
History/ Project health design
History/ Context of home environment
History/ AHRQ R01 vizHome
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/safetransitions/safetrans_guide.pdf
December 01, 2017 - Hospital discharge planning for frail older people and their family. … Discharge planning process: applying a model for evidence-based practice. … A review of discharge planning research of older adults 1990–2008. … Discharge planning from hospital to home. … Strategy 4: Care Transitions From Hospital to Home: IDEAL Discharge Planning.
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psnet.ahrq.gov/node/866562/psn-pdf
January 01, 2025 - understanding-challenges-and-successes-implementing-hybrid-interventions-healthcare-settings
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Harney_89.pdf
May 01, 2007 - dosing, and monitoring
and support of patients discharged on anticoagulation therapy with education, discharge … planning, and followup. … Planning, and Outpatient Followup
Based on our initial work on the service, adherence to recommended … Practice
Reduced Variation in Prescribing Practices
Enhanced Staff Education
Patient Education, Discharge … Planning, and Outpatient Followup
Results
Discussion
Conclusion
Limitations
Author Affiliations
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www.ahrq.gov/research/findings/final-reports/ptfamilyscan/ptfamilyex11.html
July 01, 2018 - Guide to Patient and Family Engagement
Exhibit 11. Supporting Increases in Patient Knowledge, Skills, and Abilities
Previous Page Next Page
Table of Contents
Guide to Patient and Family Engagement
Executive Summary
Introduction
Methods
Findings
Implications for the Guide
Summary and Disc…
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digital.ahrq.gov/funding-mechanism/transforming-healthcare-quality-through-information-technology-thqit-planning
January 01, 2023 - systems and a high level of integration and cooperation in four significant areas: medication management, patient … discharge, high-level integration of information, and the development of a new paradigm for evaluating
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psnet.ahrq.gov/node/73608/psn-pdf
January 01, 2022 - pharmacist-led-intervention-reduction-inappropriate-medication-use-patients-heart-failure
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/multidiscplinary-rounding.pdf
April 01, 2022 - Performance improvement specialist – safety, pressure injury, and falls concerns
• Social worker – discharge … planning
• Family members/patient – may be included when discussing the patient in particular as they
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www.ahrq.gov/research/findings/final-reports/ptfamilyscan/ptfamily3b.html
July 01, 2018 - planning. 173
Patient family-activated rapid response teams . … planning and assessing patients' understanding of discharge instructions. 32 , 194 , 203
Ensuring … planning (e.g., understanding discharge instructions). … planning. … planning.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/aspire_webinar2/aspire_webinar2.pptx
January 01, 2015 - Designing & Delivering Whole-Person Transitional Care The Hospital Guide to Reducing Medicaid Readmission Webinar 2
Designing & Delivering Whole-Person Transitional Care
The Hospital Guide to Reducing Medicaid Readmissions
Webinar 2: Analyze Data and Patient/Caregiver Perspectives
(Section 1 of the Guide)
Agenda
…
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www.ahrq.gov/patient-safety/settings/hospital/resource/guide/web3.html
December 01, 2017 - Discharge planning from all levels of care.
Disease Management.
Complex Case Management.
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psnet.ahrq.gov/node/72731/psn-pdf
February 10, 2021 - Problems in care and avoidability of death after discharge
from intensive care: a multi-centre retrospective case
record review study.
February 10, 2021
Vollam S, Gustafson O, Young JD, et al. Problems in care and avoidability of death after discharge from
intensive care: a multi-centre retrospective case record r…
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psnet.ahrq.gov/node/837658/psn-pdf
July 08, 2022 - Preventable Transfer to the Hospital
July 8, 2022
Agrawal G, Kashkouli P, Bakerjian D. Preventable Transfer to the Hospital. PSNet [internet]. 2022.
https://psnet.ahrq.gov/web-mm/preventable-transfer-hospital
The Case
A 78-year-old veteran with dementia-associated aggressive behavior and multiple comorbidities had…