Discharge and Reconciliation Programs

• ASHP-APHA Care Transitions Best Practices
  Best Practices from the ASHP-APHA Medication Management in Care Transitions Initiatives. Highlights 8 programs considering key features of each: Patient progress, pharmacy team involvement, use of technology, metrics, barriers, cost justification, and future plans.
   
• Care Transitions
  Care Transitions Intervention by Eric Coleman: framework for planning transitions using 4 pillars: Medication self-management, dynamic patient centered record, follow up, and red flags
   
• C-TraC (Coordinated transitional care)
  This includes a toolkit for coordinating discharges. Program developed by William S. Middleton Memorial VA, Madison, WI
   
• IHI Guide for improving transitions
  Sevin C, Evdokimoff M, Sobolewski S et al. How-to guide: improving transitions from the hospital to home health care to reduce avoidable rehospitalizations. Cambridge, MA: Institute for Healthcare Improvement; June 2013. A how to guide for managing transitions. includes transitions from hospital to community settings at SNF.
   
• National Transitions of Care Coalition
  National Transitions of Care Coalition; provides many tools for developing care strategy and for various care settings
   
• Project RED (re-engineered discharge)
  Provides a summary of the project conducted at Boston University Medical Center. Website has a toolkit and access to the publications on this AHRQ funded project. The components is a 12 point program, with medication issues being one of the key features.
   
• Society of Hospital Medicine Care Transitions
  Society of Hospital Medicine Collaborative on care transitions. Provides resources to analyze current workflow, select effective interventions, redesign process, educate your team, and promote a team approach.
   

2021-07