• Review the complicated process of managing transitions of care
• Assess the implementation of the Care Transitions Bundle to the various care settings in the continuum
• Discuss each of the following intervention categories:
1. Medication management & services
2. Transition planning
3. Patient & identified family caregiver engagement & education
4. Information transfer
5. Follow-up care
6. Healthcare provider engagement & share accountability across the healthcare continuum
7. Physical health, mental health & substance use disorder, social determinants of the health triune

This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME / CE credit offered for each profession.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering. 

This activity is valid from April 28, 2022, through April 19, 2025. Original webinar release date: April 20, 2022.

About The Authors

Cheri Lattimer, RN, BSN
Cheri Lattimer, RN, BSN, serves as the Executive Director for the National Transitions of Care Coalition (NTOCC) and President/CEO of Integrity Advocacy & Management. Her leadership in quality improvement, case management, care coordination, and transitions of care is known on the national and international landscape. She is affiliated with various professional organizations and maintains active roles on several national boards and committees, including URAC's Health Standards Committee, CMS Caregiver Workgroup, CMS Advisory Committee for Education and Outreach, and ABQAURP Board of Directors & CME Committee.

James Lett, MD, CMD-R, Medical Director
Dr. Lett is certified by the American Board of Family Practice with a Certificate in Added Qualifications in Geriatrics and is a Certified Medical Director Retired (CMD-R).

Dr. Lett chaired a joint national effort that created a long-term care medication toolkit for patient safety and chaired a national workgroup to create a Clinical Practice Guideline for Care Transitions in the Long-Term Care Continuum. He serves on the National Quality Forum Workgroup on Post-Acute Care and as a member of the workgroup consulting with the Office of the Inspector General (OIG) on patient harm in the long-term care continuum (SNF, IRF & LTACH). He is a past president 2003-2004 of the American Medical Directors Association (AMDA), served as a member of the CMS workgroup to revise F-Tag 329: Unnecessary Drugs.

He serves as President Board of Directors for the National Transitions of Care Coalition (NTOCC), has spoken nationally, and authored multiple articles. He was Senior Medical Director for Quality for Lumetra, the Quality Improvement Organization (QIO) for California, until assuming the role of Chief Medical Officer of Long-Term Care for the California Prison Health Care Services in 2008. From 2011-to 2013, he was Medical Director/Vice President of Medical Services at the Hebrew Home of Greater Washington, a multi-level service provider for more than 1,000 elders in Rockville, MD.

Dr. Lett recently retired as Medical/Clinical Director of Avar Consulting, Inc, in Rockville, MD, working on CMS contracts and heading their patient safety project.

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