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Transitional Care/After Care

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  • Topic: Transitional care/after care
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Keeping Children With Asthma Out of Hospitals: Parents' and Physicians' Perspectives on How Pediatric Asthma Hospitalizations Can Be Prevented

October 1, 2005 | Journal Article

Parents' and Physicians' Perspectives on How Pediatric Asthma Hospitalizations Can Be Prevented

Measuring Healthcare Outcomes to Improve Quality of Care Across Post-Acute Care Provider Settings

October 1, 2004 | Journal Article

Post-acute care (PAC) is being provided more frequently across a number of settings including skilled nursing facilities (SNFs), rehabilitation facilities (RFs) and home health agencies (HHAs).

Prisoners Returning Home in the Bronx and Brooklyn Find Reentry Services Located Far Away in Manhattan

August 27, 2009 | Program Result

An electronic database and map of reentry services available to prisoners returning from New York City's jails to communities in its five boroughs finds services are often inaccessible.

Connecting Hospitalized Patients One-on-One with Other Patients Who Have the Same Illness

May 11, 2009 | Program Result

From 1994 to 2007, staff at Friends' Health Connection (originally called Long Distance Love), New Brunswick, N.J., created and ran a program that enables hospitalized patients to communicate one-on-one with another patient who has the same illness.

Scope of Care Coordination Daunting for Physicians Treating Medicare Patients

February 16, 2009 | News Release

Typical primary care physician must coordinate care with 229 other physicians in 117 practices.

Section 5: How-To Guides

February 4, 2009 | Toolkit

How-to guides supported through TCAB, a national program of RWJF and the Institute for Healthcare Improvement, offer detailed steps to implement select aspects of the program.

A New Family-Focused Database for Bodega de la Familia's Work with Prisoners Coming Home in New York

October 31, 2008 | Program Result

Staff at Family Justice designed and implemented a comprehensive database designed to support its approach to improving the health and well-being of formerly incarcerated individuals and their families in New York.

Model Community-Based Treatment Program Reduces Hospitalization and Jail Time Among People with Mental Illness and Substance Abuse

September 29, 2008 | Program Result

Project Link is a consortium of six community service organizations to reduce repeated hospitalizations and incarcerations among a population of clients with the dual diagnoses of severe mental illness and substance abuse.

RWJF National Program, Fighting Back, Tackles Drug and Alcohol Programs in D.C.

May 1, 2005 | Program Result

From 1990 to 2001, Working Together-Fighting Back attempted to reduce the demand for illegal drugs and alcohol in Ward 7 and the eastern part of Ward 6 of the District of Columbia.

Kansas City Residents Battle Crack Houses, Public Drunkenness

May 1, 2005 | Program Result

The Fighting Back project in Kansas City worked from 1990 to 2003 to reduce the harms associated with substance abuse by consolidating existing programs and resources into a communitywide system of prevention, early identification, treatment, aftercare and relapse prevention services.

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