Care Transitions


Patients with renal disease are medically complex. Between dialysis treatments, transplant work-ups, access appointments, frequent lab draws, extended care facilities, and managing comorbid conditions, there are many opportunities to miss out on the vital communication needed to ensure seamless care transitions. When dialysis providers and community stakeholders commit to delivering high-quality, patient-centered healthcare, there is a greater opportunity to improve coordination of patient transitions between providers and to sustain positive change.

The Network, in accordance with the Centers for Medicare & Medicaid Services (CMS) and the National Transition of Care Coalition (NTOCC), is trying to increase awareness and action in the beneficiary and provider communities by elevating the importance of safe and effective care transitions between all settings to reduce medication errors and enhance clinical outcomes. Please use these resources to promote smooth care transitions in your community.

National Care Transitions Awareness Key Messages
National Care Transitions Awareness Commitment Form
Reducing Hospitalizations Booklet
Forum of ESRD Networks' Transitions of Care Toolkit