Care Transitions Program Toolkit


Care Transitions Program Toolkit


Through this 4-week program, patients with complex care needs receive specific tools, are supported by a “transition coach,” and learn self-management skills to ensure their needs are met during the transition from hospital to home.

The tool kit includes the following:

  • Intervention tools
    • Protocol manual
    • Discharge preparation checklist
    • Personal health record
    • Sample transition coach charting form
    • Coach database
    • Frequently asked questions
  • Instruments
    • Care Transitions Measure (CTM (c) TM )
    • Medical Discrepancy Tool (MDT (c) )
  • Introductory and training video
    • Care Transitions Intervention SM DVD


University of Colorado, Health Sciences Center

Funding Sources:

Paul Beeson Faculty Scholars in Aging; Robert Wood Johnson Foundation; The Commonwealth Fund


Release Date: 2006
Original Summary: October 2007
Last Updated: 09/12/08

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