Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Little is known about patient perspectives of the transition from hospital to home. ⋯ Reducing readmissions will remain challenging without a broadened understanding of the types of support and coaching patients need after discharge. We are piloting strategies such as risk stratification and tailoring of care, a specialized phone number for recently discharged patients, standardized same-day discharge summaries to primary care providers, medication reconciliation, follow-up phone calls, and scheduling appointments before discharge.