Background: Poor coordination between hospital and outpatient care worsens health outcomes, and increases preventable hospitalization and health care expenditures, especially for socioeconomically disadvantaged populations. Evidence of the effects of current programs to improve care coordination is mixed, and there is little data on how their impact may differ for hospitalizations for ambulatory care-sensitive conditions (ACSCs) [...]

Background: Poor coordination between hospital and outpatient care worsens health outcomes, and increases preventable hospitalization and health care expenditures, especially for socioeconomically disadvantaged populations. Evidence of the effects of current programs to improve care coordination is mixed, and there is little data on how their impact may differ for hospitalizations for ambulatory care-sensitive conditions (ACSCs) [...]

Background: It is challenging for care teams to learn about hospitalized older adults with Alzheimer’s Disease and other related dementias (ADRD). Life stories – interventions that collect patient’s personal narratives, histories, likes and dislikes and share them with care teams – are one innovation developed to enhance person-centered care. Few studies have explored the implementation [...]

Background: The benefits of palliative care for hospitalized cancer patients are well known and have become a hallmark of high-quality oncologic care. This evolution in cancer treatment has led to a growing demand for palliative care services, and to questions about how to most effectively integrate this specialty into patient care. Furthermore, the field of [...]