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141. Tool 1: Overview | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/redtool1.html
     March 01, 2013 - below, that the hospital undertakes during and after the hospital stay to ensure a smooth and effective transition … The result of hospitals' failure to ensure an effective transition has included adverse events, high … The goal of this theme was to measurably improve the quality of care for Medicare beneficiaries who transition

142. Tool 1: Overview | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool1.html
     March 01, 2013 - below, that the hospital undertakes during and after the hospital stay to ensure a smooth and effective transition … The result of hospitals' failure to ensure an effective transition has included adverse events, high … The goal of this theme was to measurably improve the quality of care for Medicare beneficiaries who transition

143. Case Example #6: Henry Ford Health System | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/tools/workforce-financing/case-example-6.html
     July 01, 2019 - Academic activities include the Continuity, A-PCTC (K15), and Transition of care clinics, and research … A team of resident physicians and MAs manages the care transition, usually in a single visit, and hands … MAs call patients after discharge following a protocol for transition care management. … Care and transition management of high-risk patients Care management is by RN case managers. … An MA and backup MA are dedicated to following up and scheduling patients for care-transition visits,

144. Table 1a. ADAPT Survey Respondent Characteristics (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/outcomes/chipra-146-section-6-tables-1a.pdf
     June 02, 2025 - AmeriHealth Caritas Pennsylvania Texas Children’s Health Plan Ordinal alpha Counseling on Transition … Amerihealth Caritas Pennsylvania (n=780) Texas Children’s Health Plan (n=575) P* Counseling on Transition

145. Resources | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/resources/simulation-issue-brief8.html
     July 01, 2024 - Setting Realistic Expectations Use of Simulation To Test Systems and Prepare Staff for a New Hospital Transition

146. Development of the CAHPS Nursing Home Resident Surveys | Agency for Healthcare Research and Quality
     www.ahrq.gov/cahps/surveys-guidance/nh/resident/Development-Resident-Surveys.html
     April 01, 2018 - Additional testing to develop composites and transition items .

147. Using Digital Health Tools to Improve Patient Safety during Acute Care | Agency for Healthcare Research and Quality
     www.ahrq.gov/funding/grantee-profiles/grtprofile-dalal.html
     January 01, 2024 - Care transition or moving from one healthcare setting to another, such as from the hospital to home,

148. Tool 4: Community Inventory (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool4_comm_inv.docx
     June 02, 2025 - ] · · Accountable care organization with care management or transition care [high-risk-care management

149. AHRQ Webcast Introducing the New SOPS Hospital Survey 2.0 - Ginsberg (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2-ginsberg-sops-hospital-survey-2-0-webcast.pdf
     June 01, 2020 - HSOPS 1.0) • How patient safety culture scores will be affected by changes in the survey • How to transition

150. Understanding SOPS Surveys: A Primer for New Users (Webcast) - Ginsberg (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/02-SOPS_101_Webcast-GINSBERG.pdf
     September 01, 2020 - : ► HSOPS 2.0 and HSOPS 1.0 – Last year for HSOPS 1.0; see SOPS website for suggestions on how to transition

151. Models of High Value Care for Persons with Multiple Chronic Conditions: Slide Presentation (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/mcc-summit/mcc-summit-bayliss.pdf
     June 02, 2025 - Frequent components ► Coordination/ communication, tailored assessment and care, social support, transition

152. Chapter 3. Developing Change: Designing the Medication Reconciliation Process | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/match/chapter-3.html
     July 01, 2022 - efficiencies through streamlined process steps and integration into existing workflow with consideration to transition … understanding the needs of various departments and clinical roles and responsibilities of staff at each transition … Below are various transition points that should be considered as you build a plan to improve the medication … nuances within various practice settings create challenges for medication reconciliation when patients transition

153. Chapter 3. Developing Change: Designing the Medication Reconciliation Process | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/match/chapter-3.html
     July 01, 2022 - efficiencies through streamlined process steps and integration into existing workflow with consideration to transition … understanding the needs of various departments and clinical roles and responsibilities of staff at each transition … Below are various transition points that should be considered as you build a plan to improve the medication … nuances within various practice settings create challenges for medication reconciliation when patients transition

154. Measure: Pediatric All-Condition Readmission Measure (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra_14-p008-1-ef.pdf
     October 01, 2014 - have demonstrated that QI interventions focused on improving the quality of the discharge process, the transition … Preventing the rebound: improving care transition in hospital discharge processes.

155. Society of Hospital Medicine Uses Two AHRQ Products in Hospital Discharge Toolkit | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/case-studies/cquips1002.html
     October 01, 2014 - readmission rates by providing clinicians with proven resources and expert mentoring to improve the discharge transition

156. Executive Summary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/candor-demo-program/plan-grants/summary.html
     August 01, 2022 - Patient Safety Washington State University The project found that medication discrepancies in the transition … To fill a gap in existing tools, two surveys were developed and tested to assess care transition quality

157. PQMP Measure Implementation and Quality Improvement Toolkits | Agency for Healthcare Research and Quality
     www.ahrq.gov/pqmp/implementation-qi/toolkits.html
     August 01, 2021 - An effective transition provides support to decrease the likelihood of  inappropriate care and potential

158. A Toolkit to Engage High-Risk Patients in Safe Transitions Across Ambulatory Settings (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/safetransitions/safetrans_toolkit.pdf
     December 01, 2017 - Patients who transition from one ambulatory care facility clinician to another are especially vulnerable … Patients who transition from one clinician to another are especially vulnerable to patient-safety errors … ■ Synchronous communication ■ Interoperability ■ Information that moves with the patient during transition … .4 This model, while designed for an inpatient setting, outlines the key components of a successful transition … The proposed workflow assumed the sites could identify patients who would need transition of care support

159. References | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-care-transitions7.html
     June 01, 2023 - Dropping the baton: a qualitative analysis of failures during the transition from emergency department … Transition of care practices from emergency department to inpatient: survey data and development of algorithm … Adverse events after transition from ICU to hospital ward: a multicenter cohort study. … Transition of care in the cardiothoracic intensive care unit: a review of handoffs in perioperative cardiothoracic … Ascertaining design requirements for postoperative care transition interventions.

160. Chapter 6. Measure Maps and Profiles (continued, 5) | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/care/coordination/atlas/chapter6d.html
     June 01, 2014 - Translation and validation of the Care Transition Measure into Hebrew and Arabic. … Translation and validation of the Care Transition Measure into Hebrew and Arabic.