title: Transitions in Care from the Hospital to Home for Patients With Diabetes.
abstract: In Brief Diabetes is a common coexisting chronic condition among older adults that can complicate a hospitalization and transition back to the community. The Transitional Care Model, which offers a set of time-limited, hospital-to-home services coordinated by a master's-prepared advanced practice nurse, is one option that could improve outcomes for patients with diabetes. A descriptive case study is presented.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Hirschman
authors.forename: M Brian
authors.initials: MB
authors.lastname: Bixby