Background/significance: Transitional care management (TCM) spans all healthcare settings. It begins on admission and extends along the continuum of care. Despite TCM efforts, gaps in patients’ healthcare still exist…

Contact hours available until 6/30/19…

Life after a hospital stay can have a few trials and tribulations, just like a great work of fiction. However, the patient's story is still unfolding. With care coordination support from nurse care navigators, the patient can overcome these challenges and safely complete their journey back home…