STAAR How-to Guide: Improving Transitions from the Hospital to Home Health Care to Reduce Avoidable Rehospitalizations (NOTE: Login required)

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This How-to Guide is designed to support home health care improvement teams and their hospital and community partners in co-designing and reliably implementing improved care processes to ensure that patients who have been discharged from the hospital have an effective transition into home health care in the first 48 hours after discharge from the hospital, a post-acute care setting, or a rehabilitation facility.