RT Journal Article SR Electronic T1 Optimizing transitions of care to reduce rehospitalizations JF Cleveland Clinic Journal of Medicine JO Cleve Clin J Med FD Cleveland Clinic SP 312 OP 320 DO 10.3949/ccjm.81a.13106 VO 81 IS 5 A1 Jing Li A1 Robert Young A1 Mark V. Williams YR 2014 UL http://www.ccjm.org/content/81/5/312.abstract AB Transitions of care—when patients move from one health care facility to another or back home—that are poorly executed result in adverse effects for patients. Fortunately, programs can be implemented that enhance collaboration across care settings and improve outcomes, including reducing hospital readmission rates.