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.


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

News And Research

  • ACC guidance covers bleeding in patients on oral anticoagulants

    The American College of Cardiology published an expert consensus document on managing bleeding in patients taking oral anticoagulants in its Journal of the American College of Cardiology, adding to its recent consensus report on managing anticoagulation in patients with nonvalvular atrial fibrillation. Writing committee chairman Dr. Gordon Tomaselli said the pathway provides a "conceptual framework to support clinician decision-making" for patients with bleeding complications who are taking oral anticoagulant therapy. Medscape (free registration) (12/13) Learn More

  • CMS compare websites get new quality measures

    The CMS this week added quality measures related to the influenza vaccine, methicillin-resistant Staphylococcus aureus bacteremia, and Clostridium difficile infection to its compare websites for inpatient rehabilitation facilities and long-term hospital stays. The influenza measures include the percentage of patients and health care personnel who get vaccinated. Healthcare Finance News (12/12) Learn More

  • OIG approves medication management pilot project

    The HHS Office of Inspector General approved a drug company's pilot program to give a private Medicare Advantage plan real-time access to a hospital's electronic discharge records so that plan pharmacists can use the information in patient medication management to improve transitions of care and reduce readmissions. The program participants were not identified but a vendor would provide a technology interface to allow access to the data. Healthcare Finance News (12/12) Learn More