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61. The Five Principles of Effective Primary Care-Based Care Coordination for Reducing Potentially Preventable Readmissions (pdf file)
    www.qualitymeasures.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

62. PQMP Measures | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/pqmp/measures/index.html?page=6
    March 30, 2024 - Health COE: Children's Hospital of Philadelphia (CHOP) Adolescent Assessment of Preparation for Transition

63. PQMP Measures | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/pqmp/measures/index.html?page=3
    March 30, 2024 - Children admitted to the hospital should have documentation in their hospital medical record of a transition

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

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

66. Resources and Tools To Improve Discharge and Transitions of Care and Reduce Readmissions | Agency for Healthcare Research and Quality
    www.qualitymeasures.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 …

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

68. Designing & Delivering Whole-Person Transitional Care The Hospital Guide to Reducing Medicaid Readmissions Webinar 6
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/aspire_webinar6/aspire_webinar6.pptx
    September 09, 2016 - Designing & Delivering Whole-Person Transitional Care The Hospital Guide to Reducing Medicaid Readmissions Webinar 6 Designing & Delivering Whole-Person Transitional Care The Hospital Guide to Reducing Medicaid Readmissions Webinar 6: Enhance Services for High-Risk Patients Agenda Describe strategies to enhance …

69. AHRQ Webcast Introducing the New SOPS Hospital Survey 2.0 - Sorra (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/3-sorra-sops-hospital-survey-2-0-webcast.pdf
    July 20, 2020 - . • Psychometric properties of the survey are good. 42 What’s the best way for a hospital to transition … How can hospitals transition from the SOPS Hospital Survey 1.0 (HSOPS 1 .0) to the new SOPS Hospital … HSOPS 2.0 Conclusions What’s the best way for a hospital to transition from HSOPS 1.0 to HSOPS 2.0?

70. Chapter 6. Measure Maps and Profiles (continued, 7) | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/ncepcr/care/coordination/atlas/chapter6f.html
    June 01, 2014 - coordination are Section 5 — Care Coordination, Section 6A — Family Centered Care, and Section 6B — Transition … to care coordination (Section 5— Care Coordination, Section 6A — Family Centered Care, Section 6B — Transition

71. Chapter 2. What is Care Coordination? | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/ncepcr/care/coordination/atlas/chapter2.html
    June 01, 2014 - families, and other informal caregivers experience failures in coordination particularly at points of transition … Points of transition .

72. Gurses, Ayse | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/funding/training-grants/grants/active/kawards/Kawdsumgurs.html
    October 01, 2014 - three main aims: Identify hazards that threaten post-operative cardiac surgery patients' safety in transition

73. Webinar 6: Enhance Services for High-Risk Patients | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/resource/guide/web6.html
    December 01, 2017 - 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 …

74. PowerPoint Presentation
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warm-handoff-slides-final508.pptx
    April 12, 2018 - First, the PCT-to-clinician transition of care will be a Warm Handoff Plus. … Our second type of transition will be a handoff to the lab.

75. Warm Handoff Plus (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warm-handoff-slides-final508.pdf
    April 12, 2018 - First, the PCT-to-clinician transition of care will be a Warm Handoff Plus. … Our second type of transition will be a handoff to the lab.

76. Care Coordination | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/ncepcr/research/care-coordination/index.html
    September 01, 2022 - : Practice facilitation or practice coaching is one of the most promising strategies to support the transition

77. FECC Surveys (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-166-fecc-mailed-survey.pdf
    March 09, 2018 - the main provider may have created for your child: shared care plans, emergency care plans, and transition … This is sometimes called a transition plan. Is your child age 15 or older? … Has the main provider created a written transition plan that summarizes how your child’s care will change … This is sometimes called a transition plan. 33. Is your child age 15 or older? … Has the main provider created a written transition plan that summarizes how your child’s care will change

78. Identifying Strategies to Improve Medication Safety at Home | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/funding/grantee-profiles/grtprofile-xiao.html
    November 01, 2022 - take on the responsibility for medication management, including during the high-risk period during transition

79. Slide 1
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/news/events/conference/2011/naylor/naylor.pptx
    January 01, 2011 - Slide 1 AHRQ 2011 Annual Conference Leading Through Innovation & Collaboration September 19, 2011 The Transitional Care Model Mary D. Naylor, PhD, RN, FAAN Marian S. Ware Professor in Gerontology Director, NewCourtland Center for Transitions and Health University of Pennsylvania School of Nursing Translating Resear…

80. SOPS® Database De-Identified Research Dataset Contents (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/SOPS-De-IdentifiedResearchDatasets.pdf
    January 01, 2023 - pharmacy/index.html https://www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hsops2-pt1-transition-updated.pdf