To examine the variability in post-acute care trajectories over 90 days across various settings for patients with stroke and the factors that influence this variability.
Microtransitions—defined as brief, nonurgent transitions in care—occur in post-acute and long-term care (PALTC) settings (eg, room changes, nonmedical outings, and medical outings). They occur at least as frequently as major transitions (eg, hospitalizations, discharges) and carry similar risks for adverse...
Microtransitions are brief, nonurgent transitions in care, such as room changes, recreational outings, and outpatient medical visits. Microtransitions occur at least as frequently as major transitions (eg, hospitalizations, discharges, etc.) and carry similar risks for adverse clinical outcomes if not prop...
Adverse social determinants of health (SDoH) often contribute to poor patient health outcomes after hospitalization. Although transitional care interventions can help prevent negative outcomes as patients transition from hospital to home or other health care settings, using a one-size-fits all approach may...
Older people residing in retirement villages (RVs) (elsewhere called continuing care retirement communities) are thought to live in a relatively age-friendly environment. Many RVs have facilities and resources for health care and home-based supports and opportunities for physical activity and social engage...
Persons with dementia are frequently hospitalized, which threatens their ability to return to and live at home. Current post-acute paradigms tend to default to short-term rehabilitation in a nursing home. Still, alternative post-acute care models are crucial for veterans with dementia to recover at home. T...
Older adults are at high risk of rehospitalization after an acute event and at even higher risk of permanently losing an activity of daily living with each hospitalization. This is especially true in those with encephalopathy, delirium, dementia, falls, and failure to thrive. Although it is widely known th...