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21. Coaching in the Hospital | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/patient-safety/settings/hospital/resource/nicu/coaching.html
    December 01, 2013 - provide families with the tools and support they need to promote knowledge and management of their baby's transition … The primary goal of a NICU discharge education program is to have a safe transition from the NICU to … will need equipment to create a PHR, family information, and bedside reminders to support the care transition

22. Appendix I. Measure Mapping Strategy | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/ncepcr/care/coordination/atlas/appendix1.html
    June 01, 2014 - Care Assessment Tool-Child Edition (PCAT-CE))] As Coordination Needs Change In preparation for transition … adulthood), does your provider have a process to share information with the adult care provider including: transition … Measures that focus on a particular transition point are mapped to both the before and after setting … (e.g., a measure of the transition from hospital discharge to outpatient care would map to Inpatient … were able to map all measures related to transitions to one or the other of the subdomains specifying transition

23. AHRQ's Quality & Patient Safety Programs by Setting: Hospital | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/patient-safety/settings/hospital/index.html
    March 01, 2024 - Optimizing Safe Transitions provides hospitals a comprehensive set of interventions to improve the care transition … to Home: A Resource Toolkit provides customizable resources to help hospitals and families safely transition

24. Chapter 6. Measure Maps and Profiles (continued, 5) | Agency for Healthcare Research and Quality
    www.cpsi.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.

25. NICU Family Information Packet, Appendix B, Vision Screening and Retinopathy (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb-vision.pdf
    December 13, 2013 - – Stages 1-5: degree of vasculopathy at the vascular-avascular transition (Stage 5 is most severe

26. The Five Principles of Effective Primary Care-Based Care Coordination for Reducing Potentially Preventable Readmissions (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/patient-safety/rev-reportaddendum.pdf
    March 01, 2021 - The focus should be on facilitating a smooth transition of patients and their care plans back to the … care practices can benefit from specifying and implementing an effective posthospitalization care transition

27. Information to Help Hospitals Get Started (doc file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/Ways_To_Learn_More_508.docx
    May 21, 2013 - Advancing Patient Safety organization, provides patients and families the tools that will help smooth their transition … patients with complex care needs and their family caregivers receive specific tools and work with a Transition … CoachTM to learn self-management skills that will ensure that patient needs are met during the transition

28. Tool 4: Community Inventory (doc file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool4_comm_inv.docx
    September 02, 2016 - ] · · Accountable care organization with care management or transition care [high-risk-care management

29. Strategy 4: Care Transitions From Hospital to Home: IDEAL Discharge Planning | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy4/index.html
    December 01, 2017 - Engaging patients and families in the discharge planning process helps make this transition in care safe

30. Chapter 3. Developing Change: Designing the Medication Reconciliation Process | Agency for Healthcare Research and Quality
    www.cpsi.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

31. New Models of Primary Care Workforce - Case Example #6: Henry Ford Health System (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/case_example_6.pdf
    October 01, 2016 - 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

32. Using Digital Health Tools to Improve Patient Safety during Acute Care | Agency for Healthcare Research and Quality
    www.cpsi.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,

33. Information to Help Hospitals Get Started (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/About_the_Guide_508.pdf
    May 13, 2013 - Discharge Planning helps reduce preventable readmissions by engaging patients and family members in the transition

34. Resources and Tools To Improve Discharge and Transitions of Care and Reduce Readmissions | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/patient-safety/resources/improve-discharge/index.html
    July 01, 2022 - Skip to main content An official website of the Department of Health and Human Services Careers Contact Us Español FAQs Search all AHRQ sites Search small Search Menu …

35. Information to Help Hospitals Get Started (doc file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/About_the_Guide_508.docx
    May 13, 2013 - Discharge Planning helps reduce preventable readmissions by engaging patients and family members in the transition

36. Appendix B. Clinical Materials to Share With Primary Care Providers (continued) | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/patient-safety/settings/hospital/resource/nicu/packet/apb3.html
    December 01, 2013 - Skip to main content An official website of the Department of Health and Human Services Careers Contact Us Español FAQs Search all AHRQ sites Search small Search Menu …

37. Chapter 1. Building the Project Foundation: Gaining Leadership Support Within the Organization | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/patient-safety/settings/hospital/match/chapter-1.html
    July 01, 2022 - A publication in 2001 by Rozich and Resar quantified discrepancies during key transition points such … Additional studies have validated vulnerabilities during these transition points: Variances between … preventable hospital acquired conditions and to help patients heal without complication by improving the transition

38. Webinar 3: Review & Update Readmission Reduction Efforts: Slide Presentation | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/patient-safety/settings/hospital/resource/guide/web3.html
    December 01, 2017 - Reliably deliver inpatient transition of care practices— Needs assessment.

39. Information to Help Hospitals Get Started (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/Ways_To_Learn_More_508.pdf
    October 28, 2009 - Patient Safety organization, provides patients and families the tools that will help smooth their transition … patients with complex care needs and their family caregivers receive specific tools and work with a Transition … CoachTM to learn self- management skills that will ensure that patient needs are met during the transition

40. Prologue -- Where the Rubber Meets the Road (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Leape.pdf
    April 27, 2005 - years to come, this period at the beginning of the 21st century will be regarded as a time of profound transition … At the heart of that transition is creating the culture change we need to make patient care safe.