title: Transitional care: bridging the gap.
abstract: As hospitals redesign into integrated delivery systems, new services and linkages to support patients across the care continuum become necessary. The implementation and outcomes of a transitional care program are discussed and evaluated.
authors.affiliation: Providence Saint Joseph Medical Center, Burbank, CA, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Jones
authors.forename: N
authors.initials: N
authors.lastname: Foster
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration; D006754:Hospital Restructuring; D006801:Humans; D007380:Intermediate Care Facilities / Q000458:organization & administration*; D007902:Length of Stay; D009730:Nursing Assessment; D009737:Nursing Records; D011383:Progressive Patient Care / Q000458:organization & administration*; D019467:Subacute Care / Q000458:organization & administration*