Rochester, Minnesota




The research program of Diane E. Holland, R.N., Ph.D., centers on transitioning patient care across health care settings, including hospital discharge planning and support. Her long-term research goals involve the development of processes and tools that support the best possible outcomes for patients transitioning from the hospital in order to reduce disruptive and expensive poor outcomes, such as readmissions and continuing problems and unmet needs beyond the hospital stay.

Focus areas

  • Transitioning care. Coordinating the care of patients transitioning from the hospital to their homes or other places of residence is a very important and often complicated process. Dr. Holland's research focuses on providing tools and processes that facilitate quality discharge planning initiated early in the patient's hospital stay.
  • Decision-support tools. Decision-support tools that aid the discharge planning process must be adapted for various populations and various environments. Dr. Holland's research is focusing on providing discharge planning support tools in areas such as the intensive care unit, the pediatric environment, academic medical centers and community hospitals.

Significance to patient care

Dr. Holland has developed the Early Screen for Discharge Planning, which is a screen administered to all adult patients on admission. This screen has been embedded into the electronic medical record at Mayo Clinic as well as the medical record of a number of other large medical centers.

This screen helps determine which patients are likely to have complex discharge plans, and it helps discharge planners prioritize which patients will need special attention to successfully transition care from the hospital setting. Further testing of the screen and further adaptation for diverse populations will enhance the patient transition experience.

Professional highlights

  • Fellow, Gerontological Society of America, 2011-present
  • President, National Board for Certification in Continuity of Care


See my publications

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