Care Transitions: Interventions & Tools for Providers
TMF is pleased to collaborate with the dynamic network of health care providers and stakeholders in the Lower Rio Grande Valley in the Care Transitions project. Through a communitywide collaborative effort, this project seeks to reduce the avoidable rehospitalizations of Medicare beneficiaries by implementing these strategies:
- Improving communication between providers as patients move through care settings
- Improving the use of evidence-based practices
- Providing patients with the resources that promote knowledge and self-management to better prepare them for transitions between health care settings
To help our provider partners achieve success in this project, the Care Transitions team has assembled information about the interventions as well as tools and resources that will helpful in each care setting. Follow the links below to the resources appropriate for your health care setting.