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41. AHRQ Patient Safety Roundtable: Research Priorities for Patient Safety Improvement in the Ambulatory Setting (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/ahrq-summit-agenda-2020.pdf
    January 01, 2020 - Transition 1:40 p.m. – 2:05 p.m. … Transition to Breakouts #3 and #4 and Instructions 2:45 p.m. – 3:45 p.m. … Transition 2:55 p.m. – 3:20 p.m.

42. Potentially Preventable Readmissions: Conceptual Framework To Rethink the Role of Primary Care: Final Report (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/rev-finalreport.pdf
    March 01, 2020 - These individual care transition strategies are part of a broader movement in primary care toward the … Evidence on Primary Care Transition Strategies Intervention Outcomes Primary care notifications when … A second theme is that many primary care-initiated care transition programs occurred within the context … This finding contrasts with most hospital-based care transition efforts that can be effective without … As such, primary care-based transition programs may be justified by value added either in experiential

43. Potentially Preventable Readmissions: Conceptual Framework To Rethink the Role of Primary Care: Final Report (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/rev-finalreport-update-2021.pdf
    January 01, 2021 - These individual care transition strategies are part of a broader movement in primary care toward the … Evidence on Primary Care Transition Strategies Intervention Outcomes Primary care notifications when … A second theme is that many primary care-initiated care transition programs occurred within the context … This finding contrasts with most hospital-based care transition efforts that can be effective without … As such, primary care-based transition programs may be justified by value added either in experiential

44. Transitional Care Medication Safety: Stakeholders' Perspectives | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/reports/liability/corbett.html
    August 01, 2017 - two case studies about patients experiencing medication discrepancies following a hospital to home transition … The transition from hospital to community settings is an exceptionally risky time for patients. 4-8 … Theme 1: Barriers to medication safety during transition from hospital to home. … due to illness severity and/or functional impairment. 29 During this fragile transition, patients and … Preventing or promptly resolving medication discrepancies during the hospital to home transition are

45. The Medical Home Index: Revised Short Form: Pediatric. Measuring the Organization and Delivery of Pediatric Primary Care for All Children, Youth, and Families (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/mhi-rsf.pdf
    May 29, 2013 - Transition to adulthood indicator #2.5 revised 2006; Medical Home Index revised to create MHI-RSF 2012 … Transition to adulthood indicator #2.5 revised 2006; Medical Home Index revised to create MHI-RSF 2012 … Transition to adulthood indicator #2.5 revised 2006; Medical Home Index revised to create MHI-RSF 2012 … Transition to adulthood indicator #2.5 revised 2006; Medical Home Index revised to create MHI-RSF 2012 … Adult providers offer an initial "welcome" visit and a review of transition goals.

46. Supplemental Items for the CAHPS Hospital Survey: Interpreter Services | Agency for Healthcare Research and Quality
    www.ahrq.gov/cahps/surveys-guidance/item-sets/literacy/suppl-interpreter-service-items.html
    October 01, 2023 - Add a transition statement to indicate a transition from the HCAHPS questions. … To find CMS’s mandatory transition statement, please refer to the HCAHPS Quality Assurance Guidelines … on HCAHPS and search for "mandatory transition statement."

47. Final Progress Report: Inpatient-Outpatient Transitions: Reducing the Rate of Readmissions (pdf file)
    www.ahrq.gov/sites/default/files/2025-02/jones-selna-report.pdf
    January 01, 2025 - project was to use Failure Mode Effects Analysis (FMEA) to identify modifiable risks associated with transition … These four factors are: 1) awareness of the receiving (i.e., ambulatory) party that a transition is … We first developed an idealized operational model of an inpatient-to-ambulatory care transition and, … care processes Aim 1: Develop idealized care transition model Literature review to identify … Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care.

48. Design Guide for Implementing Warm Handoffs (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warmhandoff-designguide.pdf
    December 01, 2017 - Identify all patient transition points within the practice ...................................2 Step … In each transition, opportunities arise for breakdowns in communication that may lead to medical errors … Identify all patient transition points within the practice. … For each transition identified in Step 1, determine: � Who the sender is. � Who the receiver is. … Example Table To Document Patient Transition Points Person Giving Information?

49. 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 - Scope: Over 20,000 neonates annually make the potentially risky transition from the neonatal intensive … Over 20,000 neonates make the risky transition from the neonatal intensive care unit (NICU) to home … Most errors and adverse events in this transition involve communication breakdowns in handoffs between … Most published research on this transition in pediatric patients focuses on the effect of insurance … HFMEA of a Complex Care Transition: How Did We Learn What We Learned?

50. Introducing the CAHPS Child Hospital Survey (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/20150122/4_zoe_vecchio_and_sandra_schultz.pdf
    February 11, 2015 - Customer Service Zoë Vecchio Director of Service Excellence 49 Agenda 1.CHOC’s choice to transition … to Child HCAHPS 2.Our approach to physician engagement 50 CHOC’s choice to transition to Child … CAHPS Webcast Agenda CHOC’s Choice to Transition to Child HCAHPS Our Approach to Physician Engagement

51. Overview | Agency for Healthcare Research and Quality
    www.ahrq.gov/pqmp/implementation-qi/toolkit/h2h/overview.html
    July 01, 2021 - An effective transition will support the likelihood of reducing the incidence of inappropriate care and … provided a starting place for identifying best practices for improving performance on the hospital-to-home transition

52. Table C-1. Pediatric Primary Care Measures | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/pcpaccountability/pcpacctabc1.html
    July 01, 2018 - Biopsy Follow Up 57 Reconciled Medication List Received by Discharged Patients 58 Transition … Specified Elements Received by Discharged Patients (Inpatient Discharges) 59 Timely Transmission of Transition … Record 60 Transition Record with Specified Elements Received by Discharged Patients (Emergency

53. Final Progress Report: Transitional Care Medication Safety and Reducing Medical Liability: Closing the Chasm (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/corbett-report.pdf
    January 01, 2024 - medication safety and quality of care and reduce medical liability during the hospital-to-community transition … The transition from hospital to community is an exceptionally risky time. … Data suggest that up to 90% of patients experience at least one medication discrepancy in the transition … The transition from hospital to community settings is an exceptionally risky time (Forester et al., … Data suggest that up to 90% of patients experience at least one medication discrepancy in the transition

54. Pathway to Independence in Patient-Centered Outcomes Research (PCOR) | Agency for Healthcare Research and Quality
    www.ahrq.gov/pcor/ahrq-pcor-trust-fund-training-projects/pcortf-tcdhs12007.html
    June 01, 2018 - Trust Fund RFA-HS-12-007 and RFA-HS-13-002 The Pathway to Independence Award facilitates the transition … The expected output of these grants is accelerated transition to tenure and productivity of PCOR researchers

55. Primary-Care-Based-Efforts (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/primary-care-based-efforts.pdf
    March 01, 2019 - Key Findings • The primary care-based literature on care transition programs is less developed than … Care transition programs in the context of more general primary care transformation efforts, such as … Primary care may play a small to large role in care transition interventions, and the complexity of … In both cases, a care navigator meets the patient face to face to assist in the care transition, but … Impact of an integrated transition management program in primary care on hospital readmissions.

56. Primarycareeffortstoreducereadmissions-Envscan (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/PrimaryCareEffortsToReduceReadmissions-envscan.pdf
    March 01, 2020 - Key Findings • The primary care-based literature on care transition programs is less developed than … Care transition programs in the context of more general primary care transformation efforts, such as … Primary care may play a small to large role in care transition interventions, and the complexity of … In both cases, a care navigator meets the patient face to face to assist in the care transition, but … Impact of an integrated transition management program in primary care on hospital readmissions.

57. Final Progress Report: Medication List Consistency When Patients Transition from Hospital to Community (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/kennelty-report.pdf
    January 01, 2024 - Final Progress Report: Medication List Consistency When Patients Transition from Hospital to Community … TITLE PAGE Medication List Consistency When Patients Transition from Hospital to Community Principal … This study fits into the hospital’s transition-of-care initiatives, because medication discrepancies … Mary Naylor et al. and the Care Transition by Dr. … focuses on using a care manager or nurse to aid in a seamless transition.

58. Transitions of Care | Agency for Healthcare Research and Quality
    www.ahrq.gov/topics/transitions-care.html
    Transitions of Care AHRQ's tools and research to ensure safe and seamless transitions of patients from one care setting to another, reducing preventable adverse events, drug-related errors, and other problems.  Tools TeamSTEPPS  Module on Communication Toolkit to Engage High-Risk P…

59. Table C-9. Adult Primary Care Measures Applicable to Patients with General Chronic Conditions* | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/pcpaccountability/pcpacctabc9.html
    July 01, 2018 - Outpatient Setting 57 Reconciled Medication List Received by Discharged Patients 58 Transition … Specified Elements Received by Discharged Patients (Inpatient Discharges) 59 Timely Transmission of Transition … Record 60 Transition Record with Specified Elements Received by Discharged Patients (Emergency

60. About the Measure | Agency for Healthcare Research and Quality
    www.ahrq.gov/pqmp/implementation-qi/toolkit/h2h/about.html
    July 01, 2021 - and content of discharge instructions to families/caregivers are essential for ensuring a successful transition … The measures for this toolkit were developed to capture the quality of care coordination in transition