Purpose The development and implementation of a hospitalwide, pharmacist-led transitions-
of-care (TOC) program are described. Methods This 21-week quality improvement initiative …

The competencies required by the five practice models that constitute the total pharmacy
care (TPC) model are discussed. Understanding the differences among the competencies …

Older adults with multiple chronic conditions complicated by other risk factors, such as
deficits in activities of daily living or social barriers, experience multiple challenges in …

Background Systematic attempts to identify best practices for reducing hospital readmissions
have been limited without a comprehensive framework for categorizing prior interventions …

Background Adverse outcomes are common in transitions from hospital to skilled nursing
facilities (SNFs). Gaps in transitional care processes contribute to these outcomes, but it is …

Background: Transitions of care (ToC) aim to provide continuity while preventing loss of
information that may result in poor outcomes such as hospital readmission. Readmissions …

Background Chronic diseases are long-term, recurring and prolonged, requiring frequent
travel to and from the hospital, community, and home settings to access different levels of …

Objectives The primary objective of this study was to evaluate the impact of a transitions-of-
care (TOC) program on both all-cause and related 30-day hospital readmission. The …

Background Well-executed communication among hospital providers, patients, and
receiving providers at the time of hospital discharge contributes to better health outcomes …

Background The optimal structure and intensity of interventions to reduce hospital
readmission remains uncertain, due in part to lack of head-to-head comparison. To address …