Hospital to Home

Welcome to the new and improved Hospital to Home (H2H) initiative!

Now, all H2H information and tools will be found here on the Quality Improvement for Institutions website.

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

  • S.C. program reduces readmissions 15%, Medicare data show

    Medicare data show South Carolina's Preventing Avoidable Readmissions Together program has reduced hospital readmissions by 15% in 2012 and 2013, saving more than $14 million. Many hospitals in the program improved patient communications and discharge planning, and followed up with patients at home or through skilled nursing facilities. The State (Columbia, S.C.) (7/25)

  • N.Y. medical home pilot project cuts hospital admissions

    The Adirondack Region Medical Home Pilot in upstate New York brings together 35 primary care practices, five hospitals and other clinicians who work under a global payment plan to emphasize preventive care and reduce hospital admissions. So far the project has reduced admissions 9% and increased patient satisfaction, but while data on cost savings has been mixed it has been good enough to keep insurers participating in the program. Times Union (Albany, N.Y.) (7/27)

  • Study finds inadequate info sharing during morning care hand-over

    A study in JAMA Internal Medicine revealed medical trainees on call omitted more than 40% of clinically relevant information during morning care hand-overs, and such relevant information was not recorded in medical records nearly 86% of the time. The results highlight the need for education and workflow modification to improve communication, according to the authors. (7/25)

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