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21. An Automatic Notification System for Test Results Finalized After Discharge (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/r21hs018229-dalal-annual-summary-2012.pdf
    January 01, 2012 - concern is failure of responsible providers to followup on test results finalized after a patient is discharged … The study participants were 441 patients who were discharged from the inpatient general medicine and … The study population included patients with TPADs discharged from these services if both their inpatient

22. Implementation and Evaluation of an Automated Email Notification System for Results of Tests Pending at Discharge - Final Report (pdf file)
    digital.ahrq.gov/sites/default/files/docs/publication/r21hs018229-dalal-final-report-2012.pdf
    January 01, 2012 - We activated this system for patients discharged from the inpatient general medicine and cardiology … The system continues to update the status of TPADs for each discharged patient until all are finalized … discharged from Brigham and Women's Hospital on 03/27/2011. … Results Of 1693 patients discharged with TPADs and identified by the notification system during the … Characteristics of discharged patients with TPADs appeared similar across both arms.

23. Health Information Technoloy in Heart Failure Care - Final Report (pdf file)
    digital.ahrq.gov/sites/default/files/docs/citation/k08hs023683-blecker-final-report-2018.pdf
    January 01, 2018 - Furthermore, among patients with heart failure, patients for other causes are less likely to be discharged … The heart failure cohort included patients hospitalized with heart failure who were discharged between … For the CDS cohort, we included all hospitalized patients discharged before March 31, 2018 who had … of heart failure were more likely than patients with a secondary diagnosis of heart failure to be discharged … Partly for this reason, CDS had a small effect in closing the quality gap between patients discharged

24. Evaluation of Effectiveness of a Health Information Technology-Based Care Transition Information Transfer System - 2012 | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/evaluation-effectiveness-health-information-technology-based-care-transition/annual-summary/2012
    January 01, 2012 - project was to improve the coordination of care for patients with two or more chronic conditions who were discharged … and implemented a care transition information transfer (CTIT) system for all Billings Clinic Hospital discharged … Study participants included medically complex adults discharged from an urban hospital to their rural

25. Using Health Information Technology to Improve Transitions of Complex Elderly Patients from Skilled Nursing Facilities to Home (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/r18hs017817-field-annual-summary-2012.pdf
    January 01, 2012 - medication reconciliation intervention for medication monitoring and followup of elderly patients discharged … costs required to implement an automated alert system for ambulatory physicians when patients are discharged … The study identified several additional important issues, including that older adults discharged from

26. NICU-2-HOME: Using HIT to support parents of NICU graduates transitioning home - 2011 | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/nicu-2-home-using-hit-support-parents-nicu-graduates-transitioning-home/annual-summary/2011
    January 01, 2011 - VLBW infants who are discharged, or "graduate," from the NICU have complicated home and outpatient care … Many are discharged from the hospital with special health care needs, including home oxygen and monitoring

27. NICU-2-HOME: Using Health IT to Support Parents of NICU Graduates Transitioning to Home - 2012 | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/nicu-2-home-using-hit-support-parents-nicu-graduates-transitioning-home/annual-summary/2012
    January 01, 2012 - VLBW infants who are discharged, or “graduate” from the NICU have complicated home and outpatient care … Many are discharged from the hospital with special health care needs, including home oxygen and monitoring

28. Evaluation of Effectiveness of a Health Information Technology-Based Care Transition Information Transfer System (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/r18hs017864-ciemins-annual-summary-2012.pdf
    January 01, 2012 - was to improve the coordination of care for patients with two or more chronic conditions who were discharged … implemented a care transition information transfer (CTIT) system for all Billings Clinic Hospital discharged … Study participants included medically complex adults discharged from an urban hospital to their rural

29. Using HIT to Improve Transitions of Complex Elderly Patients from SNF to Home - Final Report (pdf file)
    digital.ahrq.gov/sites/default/files/docs/publication/r18hs017817-field-final-report-2012.pdf
    January 01, 2012 - single settings and not follow complex patients as they move between settings leaves older patients discharged … We tested this intervention among adults, aged 65 and older, discharged from skilled nursing facilities … Evaluation We compared a series of measures related to the experiences of patients discharged from … Characteristics of the first 100 discharged patients during the intervention period and the matched … It is clear that older adults discharged from SNFs to home form a highly vulnerable population.

30. Schnipper, Jeffrey Lawrence | Digital Healthcare Research
    digital.ahrq.gov/principal-investigator/schnipper-jeffrey-lawrence
    January 01, 2022 - sends electronic alerts and reports to patients, caregivers, and primary care providers for patients discharged

31. An Automatic Notification System for Test Results Finalized after Discharge - 2011 | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/automatic-notification-system-test-results-finalized-after-discharge/annual-summary/2011
    January 01, 2011 - The study participants were 450 patients who were discharged from the inpatient general medicine and … The study population included patients with TPADs discharged from these services if both their inpatient

32. Using Health IT to Enable Greater Care Coordination (pdf file)
    digital.ahrq.gov/sites/default/files/docs/care-coordination-slides-051413.pdf
    May 14, 2013 - IMPLEMENTATION Supported by BWH HIT Innovations Program TPADs: Epidemiology†  41% patients discharged … acknowledgement BWH Pilot System Automated Email Notification for TPADs  Identify patients discharged …  Volume of notifications by discharged patient, provider, and test type? … 3/83) – 2 from inpatient attending – 1 from PCP Email Notifications Sent to Providers on 95 Discharged … Discharged patients with TPADs were identified by the notification system and assigned to intervention

33. Scaling Established Clinical Decision Support to Facilitate the Dissemination and Implementation of Evidence-Based Research Findings (R18) | Digital Healthcare Research
    digital.ahrq.gov/funding-mechanism/scaling-established-clinical-decision-support-facilitate-dissemination-and
    January 01, 2022 - successfully adapted and evaluated scaling of the Enhancing Quality of Prescribing Practices for Older Adults Discharged

34. Stage 3 Meaningful Use: Primary Care Provider Survey (pdf file)
    digital.ahrq.gov/sites/default/files/docs/survey/stage3-mu-primary-care-provider-survey.pdf
    February 23, 2021 - Receiving a summary record with key clinical information when a patient returns from a specialist or is discharged … hospital would… Reconciling key clinical information when a patient returns from a specialist or is discharged … a specialist RECEIVED after the patient sees the specialist RECEIVED after the patient is discharged

35. Value of Technology to Transfer Discharge Information (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/value_of_technology_to_transfer_discharge_information_2009_update_2.pdf
    January 01, 2009 - During the study, hospitalists discharged 631 patients to their homes. … Aims  Compare the benefits of discharge health information technology to usual care in recently discharged

36. Electronic Medication Adherence Reporting and Feedback During Care Transitions - Final Report (pdf file)
    digital.ahrq.gov/sites/default/files/docs/citation/r21hs024587-schnipper-final-report-2019.pdf
    January 01, 2019 - Structured Abstract: Purpose: Implement and evaluate a “smart pillbox” intervention for patients discharged … RAs contacted each subject’s inpatient unit each weekday to identify those being discharged that day. … In a study of post-discharge management of patients with diabetes mellitus discharged on insulin, we … This was for a variety of reasons, but the most common was that the patient was discharged before the … Patients who were being discharged on medications that were too soon to fill could not have previously

37. Value of Technology to Transfer Discharge Information - 2009 | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/value-technology-transfer-discharge-information/annual-summary/2009
    January 01, 2009 - During the study, hospitalists discharged 631 patients to their homes. … Aims Compare the benefits of discharge health information technology to usual care in recently discharged

38. An Automatic Notification System for Test Results Finalizes After Discharge (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/2011_018229_dalal_pdf_3.pdf
    January 01, 2011 - The study participants were 450 patients who were discharged from the inpatient general medicine and … The study population included patients with TPADs discharged from these services if both their inpatient

39. Using Health IT to Improve Care Coordination and Outcomes in Patients with Complex Health Care Needs (pdf file)
    digital.ahrq.gov/sites/default/files/docs/coordination-patients-complex-needs-slides-022014.pdf
    February 20, 2014 - 30 days2 • 50% without medical follow-up2 • Cost to Medicare in 2010: $17.5 billion3 • 19%–23% of discharged … patients suffer an adverse event4 • 36% of discharged patients do not know names or purpose of … obstructive pulmonary disease, coronary artery disease, hypertension, depression • 21 years + • Discharged … or Usually (n = 150) Baseline Intervention p-value The care transition process for patients discharged … from hospital ► Example: PCPs of patients discharged by hospitalists receive a faxed/e-mailed clinical

40. Improving Management of Test Results that Return After Hospital Discharge - Final Report (pdf file)
    digital.ahrq.gov/sites/default/files/docs/publication/k08hs018539-were-final-report-2014.pdf
    January 01, 2014 - Purpose   Nearly half of patients discharged from the hospital with pending test results experience … - Discharge summary is not available: In some rare cases, patients may have been inadvertently discharged … - Patient dies in the hospital or is discharged to hospice: We decided to leave it to the discharging … The goals of this study were to determine: (a) the follow-up patterns of patients discharged from two … from data managers at Regenstrief Institute, we queried INPC data to identify patients who (a) were discharged