Hospital to Home

The Hospital to Home (H2H) Initiative is a resource for hospitals and cardiovascular care providers committed to improving transitions from hospital to "home" and reduce their risk of federal penalties associated with high readmission rates.


Start now with an ACC (CardioSource) login, or register for access today.



Self-contained improvement projects that include a goal statement, success metrics, a tool kit, an assessment, and 3 webinars (evidence, tools, lessons learned) that provide participants with recommended strategies and tools to achieve small, attainable goals in their organization.

  • See You in 7

    The goal of the H2H SY7 Challenge is for all patients discharged with a diagnosis of HF/AMI to have a follow-up appointment scheduled/cardiac rehab referral made within 7 days of hospital discharge.

  • Mind Your Meds

    The goal of the H2H MM Challenge is for clinicians and patients discharged with a diagnosis of HF/MI to work together and ensure optimal medication management.

  • Signs and Symptoms

    The goal of the H2H S&S Challenge is to activate patients to recognize early warning signs and have a plan to address them.

Getting Started

Kick-start H2H at your hospital by utilizing the ”Getting Started Checklist.”

Get Started


Interact with others on a listserv who share best practices and lessons learned.

Find out more

News And Research

  • "Crisis mode" in hospital affects patient data exchange

    Hospital staff members who perceived a "crisis mode" in their unit were more likely to say it leads to problems in patient data exchange than those who did not perceive such a climate, research indicated. "Because effective communication during handoffs is associated with decreases in medical errors and readmissions, hospitals need to continually ensure that work environments are conducive to effective patient information exchange," study authors wrote in the Journal of Hospital Medicine. (12/17)

  • Ind. health system uses free meals to reduce readmissions

    Eskenazi Health in Indiana hopes to reduce its readmission rate from 22% to 8% by offering older patients free Meals on Wheels for two weeks after discharge. CEO Dr. Lisa Harris said hospitals "have not done our job" if patients are ready to be discharged but not ready to thrive at home. "There's nothing more foundational than nutrition," she said. The Indianapolis Star (tiered subscription model) (12/17)

  • Network says coordinated care reduces readmission rates

    Data from Chicago's Medical Home Network show 30-day readmission rates among members dropped 25% and post-discharge follow-up increased by up to 130% using a Web-based care coordination platform that alerts primary care practitioners when patients use inpatient or emergency services. A review found more Medicaid patients visited a primary care physician after hospital discharge. Health Data Management (12/16)

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