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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
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Transitional care models: preventing readmissions for high-risk patient populations
Mae M Centeno1, Kellie L Kahveci2
1Chronic Care Continuum, Institute of Chronic Disease and Care Redesign, Baylor Health Care System at Dallas, 8080 North Central Expressway, Dallas, TX 75206, USA.
Abstract:
Transition from hospital to home is a vulnerable period for older adults with multiple chronic conditions. A pilot of the Transitional Care Model at a community hospital reduced readmission rates for patients with heart failure by 48%. This article shares the experience of a large metropolitan health care system in expanding transitional care across facilities to decrease readmission rates.
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