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@ShahidNShah
@ShahidNShah
Ensure a Smooth Progression Through Care Transitions
Transitions of Care guidelines address transitions between care settings, including hospital admission and discharge to outpatient home care. Enrollment assessments help identify who may benefit from case management services and help onboard them into a case management program. Hospital and post-acute care transition planning tools support the proactive identification of barriers, including screening for social determinants of health (health-related social needs), to facilitate a smooth progression through care settings.
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