<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1657-5997</journal-id>
<journal-title><![CDATA[Aquichan]]></journal-title>
<abbrev-journal-title><![CDATA[Aquichan]]></abbrev-journal-title>
<issn>1657-5997</issn>
<publisher>
<publisher-name><![CDATA[Universidad de La Sabana]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1657-59972019000400105</article-id>
<article-id pub-id-type="doi">10.5294/aqui.2019.19.4.5</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Quality of care transition and its association with hospital readmission]]></article-title>
<article-title xml:lang="es"><![CDATA[Calidad de la transición del cuidado y su asociación con la readmisión hospitalaria]]></article-title>
<article-title xml:lang="pt"><![CDATA[Qualidade da transição do cuidado e sua associação com a readmissão hospitalar]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Weber]]></surname>
<given-names><![CDATA[Luciana Andressa Feil]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lima]]></surname>
<given-names><![CDATA[Maria Alice Dias da Silva]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Acosta]]></surname>
<given-names><![CDATA[Aline Marques]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidade Federal do Rio Grande do Sul Escola de Enfermagem ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidade Federal do Rio Grande do Sul Escola de Enfermagem ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidade Federal do Rio Grande do Sul Escola de Enfermagem ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Brazil</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2019</year>
</pub-date>
<volume>19</volume>
<numero>4</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S1657-59972019000400105&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S1657-59972019000400105&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S1657-59972019000400105&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Objective:  To evaluate the quality of care transition for patients with chronic diseases and to verify its association with hospital readmission within 30 days after discharge.  Method:  Cross-sectional epidemiological study of 210 patients with chronic diseases discharged from a hospital in southern Brazil. The Care Transition Measure-15 (CTM-15) instrument was used, through a telephone contact and, in order to identify readmissions within 30 days, the hospital management system was consulted. Student&#8217;s t-tests analysis of variance and nonparametric Pearson or Spearman correlation tests were performed.  Results:  CTM-15 score was 74.7 (± 17.1). No significant association was found between the quality of care transition and hospital readmission. 12.3 % of the patients were readmitted, and 46.2 % of these readmissions were to the emergency service.  Conclusions:  The quality of the care transition for chronic patients from inpatient units to home, showed a satisfactory score. However, there was no association between the quality of care transition and hospital readmission within 30 days after discharge.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Objetivo:  evaluar la calidad de la transición del cuidado de pacientes con enfermedades crónicas y averiguar su asociación con la readmisión hospitalaria en hasta 30 días luego del alta.  Método:  estudio epidemiológico trasversal con 210 pacientes con enfermedades crónicas que tuvieron salida de un hospital ubicado en el sur de Brasil. Se empleó el instrumento Care Transition Measure-15, por medio de contacto telefónico y, para identificar las readmisiones en hasta 30 días, se consultó el sistema de gestión hospitalaria. Se realizaron pruebas t-Student, análisis de variancia y correlación no paramétrica de Pearson o Spearman.  Resultados:  el puntaje del CTM-15 fue de 74,7 (± 17,1). No se encontró asociación significativa entre la calidad de la transición del cuidado y la readmisión hospitalaria. Se readmitió el 12,3 % pacientes, en que el 46,2 % de las readmisiones fue al servicio de urgencias.  Conclusiones:  la calidad de la transición del cuidado de enfermos crónicos de unidades de hospitalización clínica hacia el domicilio presentó un indicador satisfactorio. Sin embargo, no se encontró asociación entre la calidad de la transición del cuidado y la readmisión hospitalaria en hasta 30 días luego del alta.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[RESUMO  Objetivo:  avaliar a qualidade da transição do cuidado de pacientes com doenças crônicas e verificar sua associação com a readmissão hospitalar em até 30 dias após a alta.  Método:  estudo epidemiológico transversal com 210 pacientes com doenças crônicas que tiveram alta de um hospital no Sul do Brasil. Utilizou-se o instrumento Care Transition Measure-15, por meio de contato telefônico e, para identificar as readmissões em até 30 dias, consultou-se o sistema de gestão hospitalar. Foram realizados testes t-Student, análise de variância e correlação não paramétrica de Pearson ou Spearman.  Resultados:  a pontuação do CTM-15 foi de 74,7 (± 17,1). Não foi encontrada associação significativa entre a qualidade da transição do cuidado e a readmissão hospitalar. Foram readmitidos 12,3 % pacientes, sendo 46,2 % das readmissões no serviço de emergência.  Conclusões:  a qualidade da transição do cuidado de doentes crônicos de unidades de internação clínica para o domicílio apresentou um escore satisfatório. Entretanto, não foi verificada associação entre a qualidade da transição do cuidado e a readmissão hospitalar em até 30 dias após a alta.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Continuity of patient care]]></kwd>
<kwd lng="en"><![CDATA[patient discharge]]></kwd>
<kwd lng="en"><![CDATA[patient readmission]]></kwd>
<kwd lng="en"><![CDATA[chronic disease]]></kwd>
<kwd lng="en"><![CDATA[nursing]]></kwd>
<kwd lng="es"><![CDATA[Continuidad de la atención al paciente]]></kwd>
<kwd lng="es"><![CDATA[alta del paciente]]></kwd>
<kwd lng="es"><![CDATA[readmisión del paciente]]></kwd>
<kwd lng="es"><![CDATA[enfermedad crónica]]></kwd>
<kwd lng="es"><![CDATA[enfermería]]></kwd>
<kwd lng="pt"><![CDATA[Continuidade da assistência ao paciente]]></kwd>
<kwd lng="pt"><![CDATA[alta do paciente]]></kwd>
<kwd lng="pt"><![CDATA[readmissão do paciente]]></kwd>
<kwd lng="pt"><![CDATA[doença crônica]]></kwd>
<kwd lng="pt"><![CDATA[Enfermagem]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Goldstein]]></surname>
<given-names><![CDATA[JN]]></given-names>
</name>
<name>
<surname><![CDATA[Hicks]]></surname>
<given-names><![CDATA[LS]]></given-names>
</name>
<name>
<surname><![CDATA[Kolm]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Weintraub]]></surname>
<given-names><![CDATA[WS]]></given-names>
</name>
<name>
<surname><![CDATA[Elliott]]></surname>
<given-names><![CDATA[DJ.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Is the Care Transitions Measure associated with readmission risk? Analysis from a single academic center.]]></article-title>
<source><![CDATA[J Gen Intern Med.]]></source>
<year>2016</year>
<volume>31</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>732-8</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Harrison]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
<name>
<surname><![CDATA[Auerbach]]></surname>
<given-names><![CDATA[AD]]></given-names>
</name>
<name>
<surname><![CDATA[Quinn]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Kynoch]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Mourad]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<source><![CDATA[J Gen Intern Med.]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Trompeter]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[McMillan]]></surname>
<given-names><![CDATA[AN]]></given-names>
</name>
<name>
<surname><![CDATA[Rager]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Fox]]></surname>
<given-names><![CDATA[JR.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Medication discrepancies during Transitions of Care: a comparison study.]]></article-title>
<source><![CDATA[J Healthc Qual.]]></source>
<year>2015</year>
<volume>37</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>325-32</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Marques]]></surname>
<given-names><![CDATA[LFG]]></given-names>
</name>
<name>
<surname><![CDATA[Romano-Liber]]></surname>
<given-names><![CDATA[NS.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Segurança do paciente no uso de medicamentos após a alta hospitalar: estudo exploratório.]]></article-title>
<source><![CDATA[Saúde soc.]]></source>
<year>2014</year>
<volume>23</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1431-44</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ricci]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Araújo]]></surname>
<given-names><![CDATA[MN]]></given-names>
</name>
<name>
<surname><![CDATA[Simonetti]]></surname>
<given-names><![CDATA[SH.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Readmissão precoce em hospital público de alta complexidade em cardiologia.]]></article-title>
<source><![CDATA[Rev Rene.]]></source>
<year>2016</year>
<volume>17</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>828-34</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bonetti]]></surname>
<given-names><![CDATA[AF]]></given-names>
</name>
<name>
<surname><![CDATA[Bagatim]]></surname>
<given-names><![CDATA[BQ]]></given-names>
</name>
<name>
<surname><![CDATA[Mendes]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Rotta]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Reis]]></surname>
<given-names><![CDATA[RC]]></given-names>
</name>
<name>
<surname><![CDATA[Fávero]]></surname>
<given-names><![CDATA[MLD.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Impact of discharge medication counseling in the cardiology unit of a tertiary hospital in Brazil: a randomized controlled trial.]]></article-title>
<source><![CDATA[Clinics]]></source>
<year>2018</year>
<numero>73</numero>
<issue>73</issue>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Auerbach]]></surname>
<given-names><![CDATA[AD]]></given-names>
</name>
<name>
<surname><![CDATA[Kripalani]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Vasilevskis]]></surname>
<given-names><![CDATA[EE]]></given-names>
</name>
<name>
<surname><![CDATA[Sehgal]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Lindenauer]]></surname>
<given-names><![CDATA[PK]]></given-names>
</name>
<name>
<surname><![CDATA[Metlay]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Preventability and causes of readmissions in a national Cohort of general medicine patients]]></article-title>
<source><![CDATA[JAMA Intern Med.]]></source>
<year>2016</year>
<volume>176</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>484-93</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="book">
<collab>World Health Organization</collab>
<source><![CDATA[WHO Global action plan for the prevention and control of noncommunicable disease 2013-2020.]]></source>
<year>2013</year>
<publisher-loc><![CDATA[Geneva ]]></publisher-loc>
<publisher-name><![CDATA[World Health Organization]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Teston]]></surname>
<given-names><![CDATA[EF]]></given-names>
</name>
<name>
<surname><![CDATA[da Silva]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Garanhani]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Marcon]]></surname>
<given-names><![CDATA[SS.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reinternação hospitalar precoce na perspectiva de doentes crônicos.]]></article-title>
<source><![CDATA[Rev Rene.]]></source>
<year>2016</year>
<volume>17</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>330-7</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="book">
<collab>Brasil, Ministério da Saúde</collab>
<source><![CDATA[Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil, 2011-2022.]]></source>
<year>2011</year>
<publisher-loc><![CDATA[Brasília ]]></publisher-loc>
<publisher-name><![CDATA[Ministério da Saúde]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chibante]]></surname>
<given-names><![CDATA[CLP]]></given-names>
</name>
<name>
<surname><![CDATA[Santo]]></surname>
<given-names><![CDATA[FHE]]></given-names>
</name>
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[TD]]></given-names>
</name>
<name>
<surname><![CDATA[Pestana]]></surname>
<given-names><![CDATA[LC]]></given-names>
</name>
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[ACS]]></given-names>
</name>
<name>
<surname><![CDATA[Pinheiro]]></surname>
<given-names><![CDATA[FM.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fatores associados à internação hospitalar em clientes com doenças crônicas.]]></article-title>
<source><![CDATA[Cienc Cuid Saude.]]></source>
<year>2015</year>
<volume>14</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1491-7</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Coleman]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Mahoney]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Parry]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Assessing the quality of preparation for posthospital care from the patient&#8217;s perspective: The Care Transition Measure.]]></article-title>
<source><![CDATA[Med Care.]]></source>
<year>2005</year>
<volume>43</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>246-55</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mixon]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Goggins]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Bell]]></surname>
<given-names><![CDATA[SP]]></given-names>
</name>
<name>
<surname><![CDATA[Vasilevskis]]></surname>
<given-names><![CDATA[EE]]></given-names>
</name>
<name>
<surname><![CDATA[Nwosu]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Schildcrout]]></surname>
<given-names><![CDATA[JS.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Preparedness for hospital discharge and prediction of readmission]]></article-title>
<source><![CDATA[J Hosp Med.]]></source>
<year>2016</year>
<volume>11</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>603-9</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hirschman]]></surname>
<given-names><![CDATA[KB]]></given-names>
</name>
<name>
<surname><![CDATA[Shaid]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[McCauley]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Pauly]]></surname>
<given-names><![CDATA[MV]]></given-names>
</name>
<name>
<surname><![CDATA[Naylor]]></surname>
<given-names><![CDATA[MD.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Continuity of care: the Transitional Care Model.]]></article-title>
<source><![CDATA[Online J Issues Nurs.]]></source>
<year>2015</year>
<volume>20</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dusek]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Pearce]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Harripaul]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Lloyd]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Care transitions a systematic review of best practices]]></article-title>
<source><![CDATA[J Nurs Care Qual.]]></source>
<year>2015</year>
<volume>30</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>233-9</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mantovani]]></surname>
<given-names><![CDATA[VM]]></given-names>
</name>
<name>
<surname><![CDATA[Ruschel]]></surname>
<given-names><![CDATA[KB]]></given-names>
</name>
<name>
<surname><![CDATA[de Souza]]></surname>
<given-names><![CDATA[EN]]></given-names>
</name>
<name>
<surname><![CDATA[Mussi]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Rabelo-Silva]]></surname>
<given-names><![CDATA[ER.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Adesão ao tratamento de pacientes com insuficiência cardíaca em acompanhamento domiciliar por enfermeiros.]]></article-title>
<source><![CDATA[Acta Paul. Enferm.]]></source>
<year>2015</year>
<volume>28</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>41-7</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Acosta]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Câmara]]></surname>
<given-names><![CDATA[CE]]></given-names>
</name>
<name>
<surname><![CDATA[Weber]]></surname>
<given-names><![CDATA[LAF]]></given-names>
</name>
<name>
<surname><![CDATA[Fontenele]]></surname>
<given-names><![CDATA[RM.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Atividades do enfermeiro na transição do cuidado: realidades e desafios.]]></article-title>
<source><![CDATA[Rev enferm UFPE]]></source>
<year>2018</year>
<volume>12</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>3190-7</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="book">
<collab>The Care Transitions Program</collab>
<source><![CDATA[The care transitions intervention: health care services for improving quality and safety during care hand-offs]]></source>
<year>2014</year>
<publisher-loc><![CDATA[Aurora ]]></publisher-loc>
<publisher-name><![CDATA[CTP]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Acosta]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Lima]]></surname>
<given-names><![CDATA[MAD]]></given-names>
</name>
<name>
<surname><![CDATA[Marques]]></surname>
<given-names><![CDATA[GQ]]></given-names>
</name>
<name>
<surname><![CDATA[Levandovski]]></surname>
<given-names><![CDATA[PF]]></given-names>
</name>
<name>
<surname><![CDATA[Weber]]></surname>
<given-names><![CDATA[LAF.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Brazilian version of the Care Transitions Measure: translation and validation.]]></article-title>
<source><![CDATA[Int Nurs Rev.]]></source>
<year>2017</year>
<volume>64</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>379-87</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="book">
<collab>Brasil, Ministério da Saúde</collab>
<source><![CDATA[Resolução n.º 466 de 12 de dezembro de 2012. Aprova diretriz e normas regulamentadoras de pesquisas envolvendo seres humanos.]]></source>
<year>2012</year>
<publisher-loc><![CDATA[Brasília ]]></publisher-loc>
<publisher-name><![CDATA[Conselho Nacional de Saúde]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Anatchkova]]></surname>
<given-names><![CDATA[MD]]></given-names>
</name>
<name>
<surname><![CDATA[Barysauskas]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Kinney]]></surname>
<given-names><![CDATA[RL]]></given-names>
</name>
<name>
<surname><![CDATA[Kiefe]]></surname>
<given-names><![CDATA[CI]]></given-names>
</name>
<name>
<surname><![CDATA[Ash]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Lombardini]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Allison]]></surname>
<given-names><![CDATA[JJ.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Psychometric Evaluation of the Care Transition Measure in TRACE-CORE: Do we need a better measure?]]></article-title>
<source><![CDATA[J Am Heart Assoc]]></source>
<year>2014</year>
<volume>3</volume>
<numero>3</numero>
<issue>3</issue>
</nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ford]]></surname>
<given-names><![CDATA[BK]]></given-names>
</name>
<name>
<surname><![CDATA[Ingersoll-Dayton]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Burgio]]></surname>
<given-names><![CDATA[K.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Care transition experiences of older veterans and their caregivers]]></article-title>
<source><![CDATA[Health Soc Work.]]></source>
<year>2016</year>
<volume>41</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>129-38</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Record]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
<name>
<surname><![CDATA[Niranjan-Azadi]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Christmas]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Hanyok]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
<name>
<surname><![CDATA[Rand]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Hellmann]]></surname>
<given-names><![CDATA[DB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Telephone calls to patients after discharge from the hospital: an important part of transitions of care.]]></article-title>
<source><![CDATA[Med Educ Online.]]></source>
<year>2015</year>
<numero>20</numero>
<issue>20</issue>
<page-range>26701</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lanzoni]]></surname>
<given-names><![CDATA[GMM]]></given-names>
</name>
<name>
<surname><![CDATA[Koerich]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Meirelles]]></surname>
<given-names><![CDATA[BHS]]></given-names>
</name>
<name>
<surname><![CDATA[Erdmann]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Baggio]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Higashi]]></surname>
<given-names><![CDATA[GDC.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Myocardial revascularization: patient referral and counter-referral in a hospital institution.]]></article-title>
<source><![CDATA[Texto contexto - enferm.]]></source>
<year>2018</year>
<volume>27</volume>
<numero>4</numero>
<issue>4</issue>
</nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Day]]></surname>
<given-names><![CDATA[CB]]></given-names>
</name>
<name>
<surname><![CDATA[Witt]]></surname>
<given-names><![CDATA[RR]]></given-names>
</name>
<name>
<surname><![CDATA[Oelke]]></surname>
<given-names><![CDATA[ND.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Integrated care transitions: emergency to primary health care.]]></article-title>
<source><![CDATA[J Integr Care.]]></source>
<year>2016</year>
<volume>24</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>225-32</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Buurman]]></surname>
<given-names><![CDATA[BM]]></given-names>
</name>
<name>
<surname><![CDATA[Verhaegh]]></surname>
<given-names><![CDATA[KJ]]></given-names>
</name>
<name>
<surname><![CDATA[Smeulers]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Vermeulen]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Geerlings]]></surname>
<given-names><![CDATA[SE]]></given-names>
</name>
<name>
<surname><![CDATA[Smorenburg]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Improving handoff communication from hospital to home: the development, implementation and evaluation of a personalized patient discharge letter.]]></article-title>
<source><![CDATA[Int J Qual Health Care]]></source>
<year>2016</year>
<volume>28</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>384-90</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rosa]]></surname>
<given-names><![CDATA[ACM]]></given-names>
</name>
<name>
<surname><![CDATA[Lamari]]></surname>
<given-names><![CDATA[NM.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Caracterização de pacientes reinternados no setor de cardiologia.]]></article-title>
<source><![CDATA[Arq. Ciênc. Saúde.]]></source>
<year>2017</year>
<volume>24</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>79-83</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Reis]]></surname>
<given-names><![CDATA[MB]]></given-names>
</name>
<name>
<surname><![CDATA[Dias]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Bibanco]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Lopes]]></surname>
<given-names><![CDATA[CT]]></given-names>
</name>
<name>
<surname><![CDATA[Gea]]></surname>
<given-names><![CDATA[GN.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Readmissão hospitalar por insuficiência cardíaca em um hospital de ensino do interior do estado de São Paulo-SP.]]></article-title>
<source><![CDATA[Medicina]]></source>
<year>2015</year>
<volume>48</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>138-42</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Arbaje]]></surname>
<given-names><![CDATA[AI]]></given-names>
</name>
<name>
<surname><![CDATA[Kansagara]]></surname>
<given-names><![CDATA[DL]]></given-names>
</name>
<name>
<surname><![CDATA[Salanitro]]></surname>
<given-names><![CDATA[AH]]></given-names>
</name>
<name>
<surname><![CDATA[Englander]]></surname>
<given-names><![CDATA[HL]]></given-names>
</name>
<name>
<surname><![CDATA[Kripalani]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Jencks]]></surname>
<given-names><![CDATA[SF]]></given-names>
</name>
</person-group>
<source><![CDATA[J Gen Intern Med.]]></source>
<year>2014</year>
<volume>29</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>932-9</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
