The 6 Preventable Gaps Driving 30-Day Readmissions (Ethan Guerrieri)

The 6 Preventable Gaps Driving 30-Day Readmissions (Ethan Guerrieri)

From Home Care Strategy Lab by Miriam Allred

April 21, 2026 · 60 min · Episode 57

About this episode

Ethan Guerrieri discusses the six preventable gaps driving 30-day hospital readmissions and how his team implemented a program to address these issues.

#57 The federal government invested $500 million to understand why seniors are readmitted to the hospital within 30 days—and uncovered six key “preventable” gaps driving the problem. Ethan Guerrieri, VP of Operations at Preferred Care at Home, breaks down the research, explains each gap, and shares how his team turned these insights into their Smooth Transition Care Program. Designed for hospitals and SNFs, this evidence-based approach equips case managers and discharge planners with the tools and education they need to reduce readmissions—and shows why home care is the missing link in keeping clients safely at home. Ethan Guerrieri Preferred Care at Home Smooth Transition Care BROCHURE Smooth Transition Care FLYER Smooth Transition Care PERSONAL HEALTH RECORD Sponsors : GUIDE-Ready Respite Provider Program (Debbie Miller + Harmonic Health) CMS GUIDE Participant List (spreadsheet download)

People in this episode

Guest: Ethan Guerrieri

Topics covered

  • 30-day readmissions
  • preventable gaps
  • home care
  • Smooth Transition Care Program

Keywords

  • hospital readmissions
  • case managers
  • discharge planners
  • evidence-based approach

Mentioned in this episode

Products: Smooth Transition Care

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