The LEARNING WISDOM Phase II Scale up Project

Conditions

• Transition
• Emergencies
• Health Care Utilization
• Frailty

Interventions

• BEHAVIORAL: GEM nurse
• BEHAVIORAL: pre- and post-hospitalization medication list reconciliation
• BEHAVIORAL: systematic discharge summaries
• BEHAVIORAL: medical follow-up appointment
• BEHAVIORAL: follow-up phone call
• OTHER: Wiki-based Knowledge tools
• OTHER: Telemonitoring service

Sponsor

Laval University