Skip to main content

Care Coordination

Medical Team Looking at Xray Medical Worker

Medication Management

8Ps Risk Assessment Tool

From the Society of Hospital Medicine, this screening tool helps to identify a patient's risk for adverse events after discharge and screens for (1) problems with medications, (2) psychological issues, (3) principal diagnosis, (4) physical limitations, (5) poor health literacy, (6) patient support, (7) prior hospitalizations, and (8) palliative care.

Consumer Medication Safety Tools, a website developed by the Institute for Safe Medication Practices, offers tools and resources about high-alert medications and medication safety.


Always Use Teach-Back

The purpose of this training toolkit "Always Use Teach-Back," found at, is to help healthcare providers learn to use teach-back to support patients and families throughout the care continuum, especially during transitions between healthcare settings. The toolkit combines health literacy principles of plain language and using teach-back to confirm understanding, with behavior change principles of coaching to new habits and adapting systems to promote consistent use of key practices.

What Is Teach-Back

This video, from the Institute for Healthcare Improvement (, explains the purpose of teach-back and discusses the most important thing to keep in mind when using it with patients. 

Tools and Guides

Administration for Community Living

ADRCs have been working to assist individuals in “critical pathways,” defined as the times or places when people make important decisions about long-term care.

BOOST - Better Outcomes by Optimizing Safe Transitions

A National initiative led by the Society of Hospital Medicine to improve the care of patients as they transition from hospital to home.

Zone Tools for Patients

Asthma - English

Zone Tool for Asthma (English)

Asthma - Spanish

Zone Tool for Asthma (Spanish)