4Rosenthal JM, Miller DB. Providers have failed to work for eonti nuity [J]. Hospitals, 1979,53(10) :79 - 83.
5Coleman EA,Boult C. Improving the quality of transitional care for persons with complex care needs [J]. J Am Geriatr Soc,2003,51: 556 -557.
6Phillips CO,Wright SM, Kern DE,et al. Comprehensive discharge planning with postdischarge support for older patients with congcs tive heart failure: A meta - analysis [J]. JAMA, 2004,291( 11 ) : 1358 - 1367.
7Naylor MID, Brooten DA, CampellRL,et al. Transitional care of older adults hospitalized with heart failure: A randomized, con trolled trial[J].J AmGeriatrSoc,2004,52:675 684.
10Jencks SF,Williams MV,Coleman EA. Rehospitalizations among patients in the medicare fee - for - service program[J]. N Engl J Med,2009,360(14) :1418 - 1428.