1. Burke RE, Whitfield EA, Hittle D, et al. Hospital readmission from post-acute care facilities: risk factors, timing, and outcomes. J Am Med Dir Assoc. 2016;17(3):249-255.
  2. Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood). 2010;29(1):57-64.
  3. Center for Medicare and Medicaid Services. SNF VBP public reporting. 2017; https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst.... Accessed June 15, 2018.
  4. Ouslander JG, Lamb G, Perloe M, et al. Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs: [see editorial comments by Drs. Jean F. Wyman and William R. Hazzard, pp 760-761]. J Am Geriatr Soc. 2010;58(4):627-635.
  5. Vasilevskis EE, Ouslander JG, Mixon AS, et al. Potentially avoidable readmissions of patients discharged to post-acute care: perspectives of hospital and skilled nursing facility staff. J Am Geriatr Soc. 2017;65(2):269-276.
  6. Dusek B, Pearce N, Harripaul A, Lloyd M. Care transitions: a systematic review of best practices. J Nurs Care Qual. 2015;30(3):233-239.
  7. King BJ, Gilmore-Bykovskyi AL, Roiland RA, Polnaszek BE, Bowers BJ, Kind AJ. The consequences of poor communication during transitions from hospital to skilled nursing facility: a qualitative study. J Am Geriatr Soc. 2013;61(7):1095-1102.
  8. Tjia J, Bonner A, Briesacher BA, McGee S, Terrill E, Miller K. Medication discrepancies upon hospital to skilled nursing facility transitions. J Gen Intern Med. 2009;24(5):630-635.
  9. Popejoy L, Galambos C, Vogelsmeier A. Hospital to nursing home transition challenges: perceptions of nursing home staff. J Nurs Care Qual. 2014;29(2):103-109.
  10. Ouslander JG, Naharci I, Engstrom G, et al. Hospital transfers of skilled nursing facility (SNF) patients within 48 hours and 30 days after SNF admission. J Am Med Dir Assoc. 2016;17(9):839-845.
  11. Krol M, Jolly Graham A, Allen C, White H. Health Optimization Program for Elders (HOPE)-Improving the Transition from Hospital to Skilled Nursing Facility. Accepted for Publication (as of 9/9/2018) in the Journal of Nursing Care Quality." 
  12. Moore AB, Krupp JE, Dufour AB, Sircar M, Travison TG, Abrams A, Farris G, Mattison MLP, Lipsitz LA. Improving Transitions to Postacute Care for Elderly Patients using a Novel Video-Conferencing Program: ECHO-Care Transitions.  Am J Med. 2017 Oct; 130(10):1199-1204.


Back to TeleHOPE Main Page