Jump to content

Choose locationChoose Location
  • Sign in or Enroll
    • Open I want to choose my medical group or hospital
    • Clear my location
Change Location

We've expanded your view

You are now viewing all services in the Sutter Health network. You can change your location above to narrow your view to a medical group, hospital, city or zip.
Sutter Health
  • Video Visits
  • Find Doctors
  • Find Locations
  • Treatments & Services
  • Locations
  • Sign in or Enroll
    • Video Visits
    • Find Doctors
    • Find Locations
    • Treatments & Services
    • COVID-19 Resources
    • Pay a Bill
    • Symptom Checker
    • Get Care Today
    • Diseases & Conditions
    • Health & Wellness
    • Classes & Events
    • Research & Clinical Trials
    • For Patients
    • About Sutter Health
    • Giving
    • Volunteering
    • Careers
    • News
    • For Medical Professionals
    • Other Business Services
Close Search
  • Home
  • Research
  • Aging and Longevity
Content

Transitional Care for Older Adults

Description

This study evaluates a program to reduce hospital readmissions by engaging community-based resources to assist high-risk seniors. The grant supports Mills Peninsula Health Services in partnership with PAMF and Peninsula Family Services in the development, implementation, and evaluation of a transitional care program to reduce readmissions for patients age 65 and older. The goal of this grant is to achieve a sustained reduction in both 30- and 90-day readmission rates by at least 30% compared to a 2011 baseline

Principal Investigator

Dorothy Hung, Ph.D., M.A., MPH

Funder

Gordon and Betty Moore Foundation; Mills Peninsula Hospital Foundation

Start Date

October 15, 2010

End Date

December 15, 2014

Related Studies

Advance Care Planning Practices in Caring for Vulnerable Elders with Multiple Chronic Conditions

To examine the impact of the palliative care program on the patterns of ACP documentation in EHR of patients with multiple chronic conditions.

Investigator: Ellis C. Dillon, Ph.D. 

Advance Care Planning in Older Adults With Multiple Medical Conditions Undergoing High-Risk Surgery

Goal is to determine the prevalence of preop documentation of ACP among older, high-risk surgical pts with multiple conditions.

Investigators: Ellis C. Dillon, Ph.D., External PI, Principal Investigator 

Advancing Geriatrics Infrastructure and Network Growth

To improve individual and population health and health care through research leveraging the resources and capabilities of learning health care systems.

Aspirin in Reducing Events in the Elderly (ASPREE)

The purpose of this study is to determine whether the potential benefits of aspirin outweigh the risks for people over age 65.

Creating a Patient-Centered Tool to Help Medicare Beneficiaries Choose Prescription Drug Plans

Goals are to develop and test a tool for PAMF pts providing out-of-pocket costs in different Medicare Part D plans.

Investigators: Cheryl Stults, Ph.D., Albert S. Chan, M.D., M.S., FAAFP 

Does the Medicare Preventive Visit Coverage Benefit Seniors With Multiple Chronic Conditions?

We will assess the impact of covered preventive visits among Medicare beneficiaries using electronic health records data from PAMF, between 2006 and 2015.

Investigator: Robert Romanelli, Ph.D., MPH 

Estimating the Prevalence of Harmful and Hazardous Alcohol Consumption in Older U.S. Adults

This study incorporates data from NHANES to estimate the national prevalence of at-risk drinking among older U.S. adults.

Investigator: Sandra Wilson, Ph.D. 

Improving Outcomes for CHF Patients at a Post Acute Nursing and Rehab Facility

Purpose is to compare for CHF pts the quality of care during, and re-hospitalization rates following, SNF adm with & w/o monitoring protocols.

Investigator: Sandra Wilson, Ph.D. 

Improving the Outcomes of Older Adults with Psychosocial Vulnerability Undergoing Major Surgery.

Dr. Dillon will lead the qualitative research--data collection and analysis.

Investigators: Ellis C. Dillon, Ph.D., External PI, Principal Investigator 

Stupski Serious Illness Program Evaluation

Evaluate palliative care projects at seven healthcare organizations in the SF Bay Area.

Investigators: Ellis C. Dillon, Ph.D., Sylvia Sudat, PhD 

The Sutter Health Network of Care
Expertise to fit your needs
Primary Care

Check-ups, screenings and sick visits for adults and children.

Specialty Care

Expertise and advanced technologies in all areas of medicine.

Emergency Care

For serious accidents, injuries and conditions that require immediate medical care.

Urgent Care

After-hours, weekend and holiday services.

Walk-In Care

Convenient walk-in care clinics for your non-urgent health needs.

About Sutter

  • About Our Network
  • Annual Report
  • Awards
  • Community Benefit
  • Contact Us
  • News
  • Giving

    • Find Care

  • Birth Centers
  • Care Centers
  • Emergency Rooms
  • Hospitals
  • Imaging
  • Labs
  • Surgery Centers
  • Urgent Care
  • Walk-In Care
  • View All >

    • Featured Services

  • Behavioral Health
  • Cancer Services
  • Family Medicine
  • Home Health and Hospice
  • Orthopedics
  • Pediatrics
  • Pregnancy
  • Primary Care
  • Women's Health
  • View All >

    • Patient Resources

  • Accepted Health Plans
  • Classes and Events
  • Estimate Costs
  • Flu Resources
  • Health and Wellness
  • Medical Records
  • Medicare
  • My Health Online
  • Pay a Bill
  • Symptom Checker

    • Our Team

  • For Employees
  • Physician Careers
  • Recruiting Events
  • Sutter Careers
  • Vendors
  • Volunteers
    • ADA Accessibility
    • Contact
    • Privacy
    • Do Not Sell My Personal Information

    • LinkedIn Opens new window
    • YouTube Opens new window
    • Facebook Opens new window
    • Twitter Opens new window
    • Glassdoor Opens new window
    • Instagram Opens new window

    Copyright © 2021 Sutter Health. All rights reserved. Sutter Health is a registered trademark of Sutter Health ®, Reg. U.S. Patent & Trademark office.

    Cookie Policy

    We use cookies to give you the best possible user experience. By continuing to use the site, you agree to the use of cookies. Privacy Policy Cookie Preferences

    Privacy Policy Cookie Preferences