Kathryn Agarwal, MD

Project: "Boosting Transitions of Care for Patients with Cognitive Impairment at Houston Methodist Hospital"
Baylor College of Medicine
Texas

Fran Anderson, MA

Project: "Hampton Roads Care Transitions Project"
Senior Services of Southeastern Virginia
Virginia

Kevin Biese, MD

Project: "An ED Patient Centered Intervention to Reduce Readmission Risk for Older Adults"
University of North Carolina at Chapel Hill
North Carolina

Cyd deWaha, RN

Project: "Metro Health Hospital and Skilled Nursing Facility Collaborative"
Metro Health Hospital
Michigan

Ashley W. Harris, MD

Project: "Multi-site Implementation of INTERACT to Reduce Hospital Readmissions Within a Rural Health System"
North Mississippi Health Services
Mississippi

Steve Lai, MD

Project: "“Honoring Your Wishes” Program"
Palo Alto Medical Foundation
California

Andres F. Leone, MD

Project: "Promotion and Implementation of appropriate Palliative care for older adults"
Palmetto Health Alliance
South Carolina

Rosa Palacios

Project: "Layperson led educational and engagement program for depression care management"
Commonwealth Care Alliance
Massachusetts

Cindy Tack, LCSW, MS.MEdL

Project: "Interdisciplinary Care Management Program Integration"
MMC Physician-Hospital Organization
Maine

Amy Turk, LCSW

Project: "Health Home Connect Project"
Downtown Women’s Center
California