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recall in a rheumatology clinic","volume":"18","author":"J Anderson","year":"1979","journal-title":"Rheumatology"},{"issue":"1","key":"ref2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/S0196-0644(95)70358-6","article-title":"Comprehension of discharge instructions by patients in an urban emergency department","volume":"25","author":"J Spandorfer","year":"1995","journal-title":"Annals of Emergency Medicine"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1471-2296-6-26","article-title":"The effect of illustrations on patient comprehension of medication instruction labels","volume":"6","author":"S Hwang","year":"2005","journal-title":"BMC Family Practice"},{"issue":"5","key":"ref4","first-page":"219","article-title":"Patients\u2019 memory for medical information","volume":"96","author":"R Kessels","year":"2003","journal-title":"Journal of the Royal Society of Medicine"},{"issue":"12","key":"ref5","first-page":"1107","article-title":"Recall of discharge advice given to patients with minor head injury presenting to a Singapore emergency department","volume":"48","author":"K Heng","year":"2007","journal-title":"Singapore Medical Journal"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2147\/COPD.S16173","article-title":"Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease","volume":"6","author":"M Takemura","year":"2011","journal-title":"International Journal of Chronic Obstructive Pulmonary Disease"},{"issue":"2","key":"ref7","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1002\/ehf2.12021","article-title":"Improving care for patients with acute heart failure: before, during and after hospitalization","volume":"1","author":"M Cowie","year":"2014","journal-title":"ESC Heart Failure"},{"issue":"3","key":"ref8","doi-asserted-by":"crossref","first-page":"161","DOI":"10.7326\/0003-4819-138-3-200302040-00007","article-title":"The incidence and severity of adverse events affecting patients after discharge from the hospital","volume":"138","author":"A Forster","year":"2003","journal-title":"Annals of Internal Medicine"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1007\/s11606-014-2956-0","article-title":"Hospital discharge instructions: Comprehension and compliance among older adults","volume":"29","author":"J Albrecht","year":"2014","journal-title":"Journal of General Internal Medicine"},{"issue":"8","key":"ref10","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.mayocp.2016.05.016","article-title":"Patient, caregiver, and physician work in heart failure disease management: a qualitative study of issues that undermine wellness","volume":"91","author":"S Farmer","year":"2016","journal-title":"Mayo Clinic Proceedings"},{"key":"ref11","unstructured":"Farrell M, Scarth F. HSFR: Update and Future Directions. Oral Presentation at HealthAcheive 2016. <ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.healthachieve.com\/Presentations%202015\/Health%20System%20Funding%20Reform%20-%20Melissa%20Farrell%20and%20Fredrika%20Scarth.pdf\" xlink:type=\"simple\">http:\/\/www.healthachieve.com\/Presentations%202015\/Health%20System%20Funding%20Reform%20-%20Melissa%20Farrell%20and%20Fredrika%20Scarth.pdf<\/ext-link>. Accessed on August 22, 2017."},{"issue":"2","key":"ref12","doi-asserted-by":"crossref","first-page":"110","DOI":"10.12788\/jhm.2692","article-title":"Impact of patient-centered discharge tools: A systematic review","volume":"12","author":"K Okrainec","year":"2017","journal-title":"Journal of Hospital Medicine"},{"issue":"1","key":"ref13","doi-asserted-by":"crossref","DOI":"10.12927\/hcq.2016.24610","article-title":"Implementing Patient Oriented Discharge Summaries (PODS): A multi-site pilot across early adopter hospitals","volume":"19","author":"S Hahn-Goldberg","year":"2016","journal-title":"Healthcare Quarterly"},{"key":"ref14","article-title":"Co-creating patient-oriented instructions with patients, caregivers, and providers","author":"S Hahn-Goldberg","year":"2015","journal-title":"Journal of Hospital Medicine"},{"key":"ref15","unstructured":"Okrainec K. The Impact of a Patient-Centered Discharge Summary (PODS) on Patient Experience and Health Outcomes Following Discharge: A Multicenter Randomized Controlled Trial. Sept 2016 ed. ClinicalTrials.gov Identifier NCT02673892: National Institutes of Health, 2016."},{"issue":"1","key":"ref16","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1001\/jama.2010.896","article-title":"Can this patient read and understand written health information?","volume":"304","author":"B Powers","year":"2010","journal-title":"JAMA"},{"issue":"9","key":"ref17","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"H Hsieh","year":"2005","journal-title":"Qualitative Health Research"},{"issue":"1","key":"ref18","doi-asserted-by":"crossref","first-page":"30","DOI":"10.7748\/nr2002.10.10.1.30.c5877","article-title":"An overview of three different approaches to the interpretation of qualitative data. Part 1: theoretical issues","volume":"10","author":"H Priest","year":"2002","journal-title":"Nurse Researcher"},{"issue":"2","key":"ref19","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1080\/0013188032000133548","article-title":"Manual or electronic? The role of coding in qualitative analysis","volume":"45","author":"T Basit","year":"2003","journal-title":"Education Research"},{"issue":"4","key":"ref20","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1037\/1045-3830.22.4.557","article-title":"An array of qualitative data analysis tools: A call for data analysis triangulation","volume":"22","author":"N Leech","year":"2007","journal-title":"School Psychology Quarterly"},{"issue":"11\u201312","key":"ref21","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1111\/jocn.12773","article-title":"An observational study of older patients&apos; participation in hospital admission and discharge\u2014exploring patient and next of kin perspectives","volume":"24","author":"D Dyrstad","year":"2015","journal-title":"Journal of Clinical Nursing"},{"issue":"6","key":"ref22","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1002\/rnj.047","article-title":"Care transitions from the hospital to home for patients with mobility impairments: patient and family caregiver experiences","volume":"37","author":"A Dossa","year":"2012","journal-title":"Rehabilitation Nursing Journal"},{"issue":"4","key":"ref23","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/JCN.0b013e3181f34bb3","article-title":"Patterns of caregiving among patients hospitalized with cardiovascular disease","volume":"26","author":"L Mosca","year":"2011","journal-title":"Journal of Cardiovascular Nursing"},{"key":"ref24","unstructured":"CHPCA. Voice in Health Policy: The Role of Informal Caregivers in Hospice Palliative Care in Canada: A Discussion of the Legal, Ethical and Moral Challenges, CHPCA, August 2004, p. 9"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1186\/1472-6963-14-331","article-title":"The indispensable intermediaries: a qualitative study of informal caregivers&apos; struggle to achieve influence at and after hospital discharge","volume":"14","author":"L Bragstad","year":"2014","journal-title":"BMC Health Services Research"},{"key":"ref26","unstructured":"Statistics Canada. Visual census. 2011 census. Ottawa. <ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www12.statcan.gc.ca\/census-recensement\/index-eng.cfm\" xlink:type=\"simple\">http:\/\/www12.statcan.gc.ca\/census-recensement\/index-eng.cfm<\/ext-link>. Accessed September 19, 2016."},{"issue":"2","key":"ref27","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S0897-1897(00)80004-X","article-title":"Differences in family caregiver outcomes by their level of involvement in discharge planning","volume":"13","author":"M Bull","year":"2000","journal-title":"Appl Nurs Res"},{"issue":"2","key":"ref28","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1093\/hsw\/hlw009","article-title":"Care transition experiences of older veterans and their caregivers","volume":"41","author":"B Ford","year":"2016","journal-title":"Health & Social Work"},{"issue":"2","key":"ref29","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/0193945911400448","article-title":"Hospital to home health care transition: Patient, caregiver and clinician perspectives","volume":"34","author":"J Foust","year":"2012","journal-title":"Journal of Western Nursing Research"},{"issue":"1","key":"ref30","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/JCN.0b013e3182784123","article-title":"Challenges, needs, and experiences of recently hospitalized cardiac patients and their informal caregivers","volume":"29","author":"J Blair","year":"2014","journal-title":"Journal of Cardiovascular Nursing"},{"issue":"6","key":"ref31","doi-asserted-by":"crossref","first-page":"507","DOI":"10.3109\/13561820.2014.923988","article-title":"The perspectives of patients, family members and healthcare professionals on readmissions: Preventable or inevitable?","volume":"28","author":"L Jeffs","year":"2014","journal-title":"Journal of Interprofessional Care"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"711","DOI":"10.2147\/PPA.S36797","article-title":"Safety threats and opportunities to improve inter-facility care transitions: Insights from patients and family members","volume":"6","author":"L Jeffs","year":"2012","journal-title":"Patient Preference and Adherence"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1111\/j.1365-2702.2008.02450.x","article-title":"A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers","volume":"17","author":"Y Shyu","year":"2008","journal-title":"Journal of Clinical Nursing"},{"key":"ref34","article-title":"A time-motion study of residents and medical students performing patient discharges from general internal medicine wards: a disjointed, interrupted process","author":"A Sharma","year":"2017","journal-title":"Internal and Emergency Medicine"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1080\/00981389.2014.884037","article-title":"Hospital to community transitions for adults: Discharge planners and community service providers\u2019 perspectives","volume":"53","author":"R Chapin","year":"2014","journal-title":"Social Work in Health Care"},{"key":"ref36","first-page":"549","article-title":"Systems and people under pressure: the discharge process in an acute hospital","volume":"18","author":"M Connolly","year":"2009","journal-title":"Journal of Nursing"},{"key":"ref37","unstructured":"Ontario Ministry of Health and Long Term Care. Health System Funding Reform. <ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.health.gov.on.ca\/en\/pro\/programs\/ecfa\/funding\/hs_funding_qbp.aspx\" xlink:type=\"simple\">http:\/\/www.health.gov.on.ca\/en\/pro\/programs\/ecfa\/funding\/hs_funding_qbp.aspx<\/ext-link> Accessed on July 31, 2017."},{"issue":"12","key":"ref38","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1002\/jhm.2442","article-title":"Impact of an innovative inpatient patient navigator program on length of stay and 30-day readmission","volume":"10","author":"J Kwan","year":"2015","journal-title":"J Hosp Med"},{"issue":"0","key":"ref39","first-page":"1","article-title":"Identifying effective nurse-led care transition interventions for older adults with complex needs using a structured expert panel","volume":"00","author":"L Jeffs","year":"2017","journal-title":"Woldviews on Evidence-Based Nursing"},{"issue":"11","key":"ref40","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1111\/j.1532-5415.2004.52504.x","article-title":"Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention","volume":"52","author":"E Coleman","year":"2004","journal-title":"J Am Geriatr Soc"},{"key":"ref41","unstructured":"Jack B, Paasche-Orlow M, Mitchell S, Forsythe S, Martin J, Brach C. Re-Engineered discharge (RED) toolkit. Agency for Healthcare Research and Quality. 2013. <ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.ahrq.gov\/sites\/default\/files\/publications\/files\/redtoolkit.pdf\" xlink:type=\"simple\">https:\/\/www.ahrq.gov\/sites\/default\/files\/publications\/files\/redtoolkit.pdf<\/ext-link>. Accessed on August 22, 2017."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/dx.plos.org\/10.1371\/journal.pone.0197831","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,5,9]],"date-time":"2020-05-09T18:01:57Z","timestamp":1589047317000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0197831"}},"subtitle":[],"editor":[{"given":"Gijs","family":"Hesselink","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2018,5,24]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2018,5,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0197831","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,24]]}}}