{{ (moduleVm.actions && moduleVm.changeStatus) ? moduleVm.status : '' }} Effective Care Transitions: Reducing Readmissions to Improve Patient Care and Outcomes

Activity Steps


The authors describe the implementation of a collaboratively developed care transition model between a health system population health management office and a primary care organization. This QI project demonstrated that an effective care transitions model is stronger with collaboration among core members of a patient?s care team, including a nurse care manager and a primary care provider.

Learning Objectives

After completing this continuing education activity you will be able to:

  1. Identify the concepts and key elements of transition models of care.
  2. Summarize information about the authors' QI project.
  3. Discern the role and potential benefits of care management practice for patients transitioning from the hospital to home.

Learning Outcomes

A majority of the participants of this activity will demonstrate knowledge of a quality improvement project that implemented effective care transitions to help improve patient care and outcomes by reducing readmissions by achieving a passing score on the posttest.
Price: $21.95


  • NAHQ 2.0 CEH

This continuing education (CE) activity is provided by Lippincott Professional Development and has been approved by the National Association for Healthcare Quality (NAHQ) for 2.0 CPHQ CE Hours. CPHQ CE Hours are based on a 60-minute hour. This CE is approved for meeting requirements for certification renewal.

Test Code: PCM0324BHQ
Published: Mar/Apr 2024
Expires: 3/1/2025
Required Passing Score: 8/10 (80%)
Authors: Tara Kinard, MSN, MBA, RN, ACM-RN, CCM, CENP; Jill Brennan-Cook, DNP, RN, GERO-BC; Sara Johnson, MBA, PMP; Andrea Long, PharmD; John Yeatts, MD, MPH; David Halpern, MD, MPH, FACP