- Content Library
- Product Library
- Geriatrics Competencies
- Competency-Matched Products for Medical Students (G-Wiz)
- Competencies: Side-by-Side Comparison (MS, IM-FM, EM)
- Medical Student Competencies
- IM-FM Competencies
- Emergency Medicine Competencies
- Geriatric Fellowship Learning Objectives
- Nursing Competencies
- Geropsychiatric Nursing Competency Enhancements
- Multiprofessional Competencies
- Archives
- Help
- About Us
Transitions of Care
Transitions of Care
Selected articles and automatically-renewing searches on the topic of transistions of care
Core Concepts
|
Practice Guidelines
|
Core Concepts
Wenger NS, Young RT. Quality indicators for continuity and coordination of care in vulnerable elders. J Am Geriatr Soc. 2007;55 Suppl 2:S285-92.
Key Review Articles
Coleman EA.Falling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous complex careneeds. J AmGeriatr Soc. 2003;51( 4):549-555
Coleman EA, Boult C, American Geriatrics SocietyHealth Care Systems Committee. Improving the quality of transitional care for persons with complex care needs. JAm Geriatr Soc. 2003;51( 4):556-557.
Hughes RG, Clancy CM. Improving the complex nature of care transitions. J Nurs Care Qual. 2007;22( 4):289-292.
Flacker J, Park W, Sims A. Hospital discharge information and older patients: do they get what they need? J Hosp Med. 2007;2(5):291-6. PubMed PMID: 17935256.
Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: A review of key issues for hospitalists. J Hosp Med. 2007;2( 5):314-323.
Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA. 2007;297( 8):831-841.
Oakes SL, Gillespie SM, Ye Y, Finley M, Russell M, Patel NK, Espino D. Transitional care of the long-term care patient. Clin Geriatr Med. 2011 May;27(2):259-71. PubMed PMID: 21641510.
Shepperd S, McClaran J, Phillips CO, Lannin NA, Clemson LM, McCluskey A,Cameron ID, Barras SL. Discharge planning from hospital to home. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD000313.
Assessment and Mangement
Golden AG, Martin S, da Silva M, Roos BA. Care management and the transition of older adults from a skilled nursing facility back into the community. Care Manag J. 2011;12(2):54-9. PubMed PMID: 21717847Walker C, Hogstel MO, Curry LC. Hospital discharge of older adults. how nurses can ease the transition. Am J Nurs. 2007;107( 6):60-70; quiz 71.
Practice Guidelines
American Medical Directors Association. Transitions of Care in the Long-Term Care Continuum Practice Guideline. Columbia, MD: AMDA 2010
National Guideline Clearinghouse (NGC).Guideline summary: Discharge planning for the older adult. In: National Guideline Clearinghouse(NGC)[website]. Rockville(MD): [cited 2008 Jan08]. Available:http://www.guideline.gov
Hickman L, Newton P, Halcomb EJ, Chang E, Davidson P. Best practice interventions to improve the management of older people in acute care settings: A literature review. J Adv Nurs. 2007;60( 2):113-126.top
Health Services and Models of Care
Boyd CM, Boult C, Shadmi E, et al. Guided care for multimorbid older adults. Gerontologist. 2007;47( 5):697-704.Buurman BM, Parlevliet JL, van Deelen BA, de Haan RJ, de Rooij SE. A randomised clinical trial on a comprehensive geriatric assessment and intensive home follow-up after hospital discharge: the Transitional Care Bridge. BMC Health Serv Res. 2010 Oct 29;10:296. PubMed PMID: 21034479.
Clarfield AM, Bergman H, Kane R. Fragmentation of care for frail older people--an international problem. experience from three countries: Israel, Canada, and the United States. J Am Geriatr Soc.2001;49( 12):1714-1721.
Halasyamani L, Kripalani S, Coleman E, et al. Transition of care for hospitalized elderly patients--development of a discharge checklist for hospitalists. J Hosp Med. 2006;1( 6):354-360.
Hickman L, Newton P, Halcomb EJ, Chang E, Davidson P. Best practice interventions to improve the management of older people in acute care settings: A literature review. J Adv Nurs. 2007;60( 2):113-126.
Merriman ML. Pre-hospital discharge planning: Empowering elderly patients through choice. Crit Care Nurs Q. 2008;31( 1):52-58.
Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database Syst Rev. 2006;(4)( 4):CD004510.
Naylor MD. A decade of transitional care research with vulnerable elders. J Cardiovasc Nurs. 2000;14( 3):1-14; quiz 88-9.
Ouchida K, LoFaso VM, Capello CF, Ramsaroop S, Reid MC. Fast forward rounds: an effective method for teaching medical students to transition patients safely across care settings. J Am Geriatr Soc. 2009 May;57(5):910-7. PubMed PMID: 19368582.
Smith SM, Allwright S, O'Dowd T. Effectiveness of shared care across the interface between primary and specialty care in chronic disease management. Cochrane Database Syst Rev. 2007;(3)( 3):CD004910.
Walker C, Hogstel MO, Curry LC. Hospital discharge of older adults. how nurses can ease the transition. Am J Nurs. 2007;107( 6):60-70; quiz 71.
Wright K, Hazelett S, Jarjoura D, Allen K. The AD-LIFE trial: working to integrate medical and psychosocial care management models. Home Healthc Nurse. 2007;25(5):308-14. Review.
Social Issues
Gravolin M, Rowell K, de Groot J. Interventions to support the decision-making process for older people facing the possibility of long-term residential care. Cochrane Database Syst Rev. 2007;(3)( 3):CD005213.McCloskey R, van den Hoonaard D. Nursing home residents in emergency departments: A foucauldian analysis. J Adv Nurs. 2007;59( 2):186-194.
Parsons P, Boling PA. Patterns of emergency care use in residential care settings: Opportunities to improve quality of transitional care in the elderly. Home Health Care Serv Q. 2007;26( 4):79-92.
van Servellen G, Fongwa M, Mockus D'Errico E. Continuity of care and quality care outcomes for people experiencing chronic conditions: A literature review. Nurs Health Sci. 2006;8( 3):185-195.
PubMed Alerts
View the most recently indexed articles in PubMed addressing:
Transitional Care in the ElderlyInterdisciplinary Issues
Carr DD. Case managers optimize patient safety by facilitating effective care transitions. Case Manag. 2007;12( 2):70-80; quiz 81-2.Crotty M, Rowett D, Spurling L, Giles LC, Phillips PA. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? results of a randomized, controlled trial. Am J Geriatr Pharmacother. 2004;2( 4):257-264.
Levenson SA, Saffel DA. The consultant pharmacist and the physician in the nursing home: Roles, relationships, and a recipe for success. J Am Med Dir Assoc. 2007;8( 1):55-64.
Mion L, Odegard PS, Resnick B, Segal-Galan F, Geriatrics Interdisciplinary Advisory Group, American Geriatrics Society. Interdisciplinary care for older adults with complex needs: American Geriatrics Society position statement. J Am Geriatr Soc. 2006;54( 5):849-852
Preyde M, Macaulay C, Dingwall T. Discharge planning from hospital to home forelderly patients: a meta-analysis. J Evid Based Soc Work. 2009;6(2):198-216.
Watters CL, Moran WP. Hip fractures--a joint effort. Orthop Nurs. 2006;25( 3):157-65; quiz 166-7.
- 235 reads