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Table 2 Frequency of measured items using the original group of patients (N=24)

From: Evaluation of a modified community based care transitions model to reduce costs and improve outcomes

  Total Number Percent
Reported averted care visits (hospital or office) 11 45.8
Appointment assistance 10 41.7
Follow up appointment(s) scheduled 21 87.5
Transportation to appointment(s) in place 20 83.3
Follow up scheduled within 7 days 10 41.7
Follow up scheduled with specialist 19 79.2
Medication reconciliation 21 87.5
Medication education 21 87.5
Education on condition red flags 22 91.7
Education on condition specific information 22 91.7
Received individualized care plan 22 91.7
Hospital A referrals 12 50
Hospital B referrals 12 50
Reported unplanned care visits 5 20.8
Depression screening completed 10 41.7
Mobility screening completed 10 41.7