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Patient transitions from the hospital to post-acute care providers, including home health agencies, continue to be plagued by incomplete medical records and missing information. Gaps in post-acute caretransitions are so common, in fact, that the U.S.
Effective communication during caretransitions, along with proper medication reconciliation, is vital for preventing readmissions and improving overall patient outcomes. This program underscores the importance of improving caretransitions to minimize patient readmissions within a 30-day timeframe post-discharge.
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