The Care Transitions Program

Eric A. Coleman, MD, MPH - Health Care Services for Improving Quality and Safety during Care Hand-offs

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  • Home
  • Tools and Resources
    • Download Our Tools
    • On the
      Cutting Edge
    • Our Publications
    • State of the Art Goals Curriculum
  • Are You a Patient or Family Caregiver?
    • Leaving the hospital: What you must know
    • Tips for Managing care at home
    • Recognizing Red Flags
    • Managing Medication
    • Links and Resources
  • Contact Us

About the Care Transitions Intervention®

What is a Transitions Coach®?

The Transitions Coach® is key to encouraging the patient and family caregiver to assume a more active role in their care. The Transitions Coach® does not fix problems and does not provide skilled care though she or he possesses these skills from prior health professional training.

Rather, Transitions Coaches® model and facilitate new behaviors, skill transfer, and communication strategies for patients and families to build confidence that they can successfully respond to common problems that arise during care transitions. The patient’s goal drives the agenda.

Thus the role of the Transitions Coach® is to promote more effective care transitions through improved self-management skills, and enhanced patient-provider communication.

The Transitions Coach in Action®

If you would like to better understand the role of the Transitions Coach®, we invite you to watch one or more of these vignettes.

Coaching Interaction 1


Coaching Interaction 2


Coaching Interaction 3


Health care services for improving quality care and safety of patients during transitions across care settings

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Disclaimer: The Care Transitions Program® and its personnel assume no liability or risk for use of model, materials or any advice explicit or implicit.

The John A. Hartford Foundation Gordon and Betty More Foundation  School of Medicine Health Care Policy and Research