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Interventions That Improve Transitional Care and Reduce Readmission Rates. Madison Griffin, BSN Student Chealsey Brock, BSN Student . Introduction. Results. Methods. 158 patients aged 65 years or older initially hospitalized with a chronic disease.

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  1. Interventions That Improve Transitional Care and Reduce Readmission Rates Madison Griffin, BSN Student Chealsey Brock, BSN Student Introduction Results Methods • 158 patients aged 65 years or older initially hospitalized with a chronic disease. • Evaluated over a year span • Nurse practitioner was employed as a transition coach • Transition coach communicated with the patient and their caregiver concerning treatment and education • . To test whether an intervention designed to encourage older patients and their caregivers to assert a more active role during care transitions can reduce rehospitalization rates. Interventions & Conclusion • medication self-management • a patient-centered record • primary care and specialist follow-up • knowledge of ‘‘red flags’’ warning symptom or sign indicative of a worsening condition • *Patients involved in intervention were half as likely to return to the hospital as those who were not References • Your text goes here.

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