This report looks at one important component of care coordination: transition from inpatient care back to the community. The purpose of the project was to identify potential problem areas in such transitions and to identify relevant quality measures. In the current study, special emphasis is placed on communications from larger referral hospitals back to rural residents and their rural primary care physicians. This study suggests ways of measuring the quality of care coordination on discharge from the hospital.
The policy brief for this report can be found here.