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Transitional Care Can Reduce Hospital Readmissions

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Transitional Care Can Reduce Hospital Readmissions

Understanding Transitional Care


Transitional care refers to a collection of services aimed at ensuring optimal communication and coordination of services to provide continuity of safe, timely, high-quality care during transitions. Optimal management of care transitions includes patient and family education, coordination and arrangement of care in the post-acute care setting, and aiding communication among healthcare professionals involved in the patient's care transition.

Several transitional-care programs have gone through randomized controlled trials and been found to significantly lower readmission rates, with reductions up to 45%. These programs incorporate such services as comprehensive discharge planning, post-discharge telephone outreach, home visits, patient-centered discharge instructions, followup with a primary care provider, and medication reconciliation.

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