Care Coordination and Transition Management (CCTM) Toolkit

To access the CCTM Toolkit, you must be logged in as a member of AAACN.

If you are a current member, simply log in for access.

If you aren't a member, please join AAACN now to enjoy access to this toolkit and so many other benefits of membership.

This toolkit was designed to assist nurses and leaders working in the ambulatory care setting to develop and/or improve care coordination and transition management for patients.

Contained within are all the necessary materials to design, implement, or improve a CCTM program; including structure, process, and outcome tools.

Examples of some of these tools include: job descriptionsorientation programspolicies and procedures, and best practice outcome metrics.

To maintain the ongoing relevance and value of this toolkit, we welcome your feedback and suggestions.