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Transitional Care Management care team impact on no-show rates to hospital discharge appointments [Patient education/adherence]

Annals of Family Medicine

Referrals were not placed for patients being discharged to another facility or who already had an outside primary care provider. A referral order was created in the hospital system’s electronic health record to the "Hospital Discharge Clinic," and referrals were placed for urgent (7-day) or routine (14-day) TCM appointments.