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Transitional Care/After Care

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  • Topic: Transitional care/after care
  • Topic: Continuum of care
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Aftercare Treatment Coordinated for Mentally Ill, Substance Abusing Teens in One New Jersey County

September 1, 2000 | Program Result Report

The Middlesex County Educational Services Commission developed and implemented the first aftercare service in Middlesex County, N.J., for mentally ill youth completing treatment for substance abuse.

Recent Research About Nursing, August 2010

August 18, 2010 | Story

New studies give a thumbs-up to a nurse-managed program to prevent second heart attacks, and tally the costs of preventable medical errors.

Smoothing the Transition From Hospital to Community for Older Adults in Jacksonville, Fla.

December 7, 2011 | Story

Mark LeMaire led a community partnership in Jacksonville, Fla., that placed elder care advocates in area hospitals to help discharged patients transition back to the community. The hospitals have since incorporated the program into their operations.

Collecting Data to Identify Disparities and Measure Heart Care Quality

March 24, 2010 | Story

Duke University Hospital and the health system wanted to improve cardiac care for African-American and Latino populations by identifying and analyzing disparities and developing tools that would better serve them.

Improving Heart Care through Better Data and Communications

March 24, 2010 | Story

A multidisciplinary team redesigned Montefiore Medical Center's patient registration system to collect data on race, ethnicity and preferred language, and developed a procedure to provide faster treatment for heart attack patients.

Combining Better Systems and Intensive Patient Education for Better Heart Care

March 24, 2010 | Story

Del Sol Medical Center improved its patient chart review and discharge processes, and enhanced its heart failure center, with support from Expecting Success.

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).

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.

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