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Some studies suggest that the benefits of transitional care extend beyond 30-days after hospital discharge. 10 The benefit of transitional care includes reduced future readmissions, a reduction in medication complications, and increase in high-value care for the patient. 6 Comprehensive discharge planning and follow-up has been shown to reduce hospital readmissions 30 days postdischarge, 7-9 and the benefit of these programs extends to physicians and their practices. 3,4 In January 2013, the Center for Medicare and Medicaid Services (CMS) created new billing codes (99495, 99496) to address the work involved in coordinating postdischarge services, 5 incentivizing TCM programs by increasing reimbursements to physicians who provide transitional care. 1 Adherence to treatment plans can be low, 2 and nonadherence to discharge instructions is associated with poor health outcomes. Transitional care management (TCM) is a robust intervention to guide a patient’s transition from a hospital setting to an outpatient follow-up visit with a primary care physician. Follow-up analysis indicated significant associations between readmission rates and any level of TCM care at 60 ( χ 2=5.40, P=.02) and 90 ( χ 2=4.21, P=.04) days, but not at 30 days ( χ 2=1.39, P=.28).Ĭonclusions: Our TCM program review suggests that the benefits of transitional care extend beyond 30 days by decreasing readmission rates at 60 and 90 days after hospital discharge. We conducted χ 2 analysis, one-way analysis of variance, and unpaired t tests to assess associations between readmission rates or costs and TCM care.
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We collected patient demographics, readmissions, and visit costs using manual chart review and electronic health record (EHR) data extraction. We coded patient contact as (1) no successful phone-call contact, patient did not attend appointment (2) successful phone-call contact, patient did not attend appointment and (3) patient attended appointment. Methods: The TCM team contacted patients upon discharge to schedule the follow-up appointment. We aimed to evaluate the efficacy and self-sustainability of this TCM program. In 2017, the department of primary care internal medicine (PCIM) at Eastern Virginia Medical Group implemented TCM. It can export references to different formats, including BibTeX.Background: Transitional care management (TCM) programs guide patients from hospital discharge to outpatient follow-up with the goal to decrease hospital readmissions and the cost of care.
#Transition from bibdesk to jabref pdf#
I use Zotero, which is a powerful open source Firefox plugin that keeps a database of your references, including local copies of PDF files and websites.
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In particular, it can download PDFs and link the bibliographic entry with the downloaded PDF (this functionality is contained in the "File" field of the "General" tab of the BibTeX entry editor). JabRef is an open-source, cross-platform BibTeX reference manager with much of the same functionality as Bibdesk. The PDF exportedĪlong with the comments can be readily viewed in Adobe's Reader. With Mendeley you can view and annotate PDF files.

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