title: Transitional care: focusing on patient-centered outcomes and simplicity.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Bray-Hall
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D010351:Patient Discharge / Q000592:standards*; D062209:Patient Handoff; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D020521:Stroke / Q000628:therapy*