Coordinate assessment, care planning, referrals, follow-up, and communication across a person’s care team.
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Implementation PathwayHospitals & Health Systems
Build continuity between hospital services, ambulatory teams, and community partners.
01 / Designed for your team
Connect care across settings.
Hospital leaders, discharge planners, case managers, clinical teams, and community partnership staff.
02 / What you’ll work throughMake the connections
Make the connections
that care depends on.
01
Map discharge, handoff, and follow-up processes.
02
Connect hospital teams with community services and outpatient care.
03
Identify information needed to coordinate care after discharge.
04
Track transition activities, unresolved needs, and program results.
04 / Keep building
Related learning.
Combine a shared foundation with courses that fit your team’s responsibilities.
Your next stepSupport as
Support as
you put it into practice.
Explore proposed workshops, office hours, and tools for mapping workflows and reviewing progress.
Explore implementation support