Journal of General Internal Medicine

, Volume 24, Issue 8, pp 971–976 | Cite as

Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine

  • Vincenza SnowEmail author
  • Dennis Beck
  • Tina Budnitz
  • Doriane C. Miller
  • Jane Potter
  • Robert L. Wears
  • Kevin B. Weiss
  • Mark V. Williams
Health Policy


The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.


Electronic Health Record Medical Home Care Transition Transition Record Academic Emergency Medicine 
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Conflict of Interest Statements


Conflict of Interest Statement for Faculty, Authors, Members of Planning Committees and Staff

American College of Physicians – Society of Hospital Medicine – Society of General Internal Medicine

The following members of the Steering (or Planning) Committee and Staff of the Transitions of Care Consensus Conference have declared a Conflict of Interest:

Dennis Beck, MD, FACEP (ACEP Representative) President and CEO, Beacon Medical Services has declared conflict of interest of Stocks/Holdings: 100 units of stock options/holdings in Beacon Hill Medical Services

Tina Budnitz, MPH (SHM Staff) Senior Advisor for Quality Initiatives Society of Hospital Medicine has declared conflict of interest of Employment: Staff, Society of Hospital Medicine

Eric S. Holmboe, MD (ABIM Representative) Senior Vice President Quality Research and Academic Affairs American Board of Internal Medicine has declared conflict of interest of Employment: SVP Quality Research and Academic Affairs American Board of Internal Medicine

Vincenza Snow, MD, FACP (ACP Staff) Director, Clinical Programs and Quality of Care American College of Physicians has declared conflict of interest of Research grants: CDC, Atlantic Philanthropies, Novo Nordisk, Bristol Myers Squibb, Boehringer Ingelheim, Pfizer, United Healthcare Foundation, Sanofi Pasteur

Laurence D. Wellikson, MD, FACP (SHM Staff) Chief Executive Officer Society of Hospital Medicine has declared conflict of interest of Employment: CEO, Society of Hospital Medicine

Mark V. Williams, MD, FACP (Co-Chair, SHM Representative) Editor-in-Chief, Journal of Hospital Medicine Past-President, Society of Hospital Medicine has declared conflict of interest of Membership: Society of Hospital Medicine

The following members of the Steering (or Planning) Committee and Staff of the Transitions of Care Consensus Conference have declared No Conflict of Interest:

David Atkins, MD, MPH, (AHRQ Representative)

Associate Director, QUERI, Department of Veteran Affairs, Office of Research and Development, Health Services Research & Development (124)

Doriane C. Miller, MD (Co-Chair, SGIM Representative)

Associate Division Chief, General Internal Medicine, Stroger Hospital of Cook County

Jane Potter, MD (American Geriatric Society Representative)

Professor and Chief of Geriatrics, University of Nebraska Medical Center

Robert L. Wears, MD, FACEP (Society for Academic Emergency Medicine Representative)

Professor, Department of Emergency Medicine, University of Florida

Kevin B. Weiss, MD, MPH, MS, FACP (Chair, ACP Representative)

CEO, American Board of Medical Specialties

Financial Support Statement

The TOCCC was funded under an unrestricted educational grant from Novo Nordisk, as part of the ACP Diabetes Initiative, and from the AHRQ. The funders had no input into the planning, structure, content, participants, or outcomes of the conference.


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Vincenza Snow
    • 1
    Email author
  • Dennis Beck
    • 2
  • Tina Budnitz
    • 3
  • Doriane C. Miller
    • 4
  • Jane Potter
    • 5
  • Robert L. Wears
    • 6
  • Kevin B. Weiss
    • 7
  • Mark V. Williams
    • 8
  1. 1.American College of PhysiciansPhiladelphiaUSA
  2. 2.Beacon Medical ServicesAuroraUSA
  3. 3.Society of Hospital MedicinePhiladelphiaUSA
  4. 4.University of Chicago Medical CenterChicagoUSA
  5. 5.University of NebraskaLincolnUSA
  6. 6.University of FloridaGainesvilleUSA
  7. 7.American Board of Medical SpecialtiesChicagoUSA
  8. 8.Northwestern UniversityChicagoUSA

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