 This study addresses the Patient-Centered Outcomes Research Institute PCORI area of interest related to development of decision support tools that bring patients, families and clinicians together to decide, in this instance, whether or not transfer from the nursing home NH to acute care is necessary and appropriate. The purposes of this study were 1 to develop an evidence-based decision aid addressing potentially avoidable transfers of residents from nursing homes to hospitals preceded this protocol, and 2 to evaluate this decision aid in terms of acceptability to residents and families and its effect on the quality of transfer decisions. 