Aligning Forces for Quality (AF4Q) Alliances have implemented or are partnering in care transitions programs to ensure patient care that is coordinated across care settings. This brief highlights the successes of alliances that have developed relationships with organizations and providers in the community so they can collaborate to reduce hospital readmissions.

To read the rest of this brief, see Building Relationships with Providers, Identifying and Recruiting Patients for Participation, Improving Handoffs, Tracking Performance Metrics, Creating a Behavioral Health Intervention, Supporting Patients Who Are Nearing the End of Life, and Hiring Care Transition Coaches.