Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: E-Coaching: IVR-Enhanced Care Transition Support for Complex Patients
Brief Summary: For complex medical patients, the transition from hospital to home-based care is a vulnerable period, placing the patient at high risk for adverse events. Using a Care Transition conceptual model, the investigators propose developing and evaluating, through a randomized controlled trial, "e-Coach," an Interactive-Voice-Response-supported (IVR) Care Transition coaching intervention, focused initially on patients hospitalized with heart failure or obstructive lung disease. This trial will test the primary hypothesis that the proportion of patients with one or more re-hospitalizations during a 90-day post-discharge follow-up period will be less in an IVRsupported care transition intervention (e-Coach) compared to a "usual care" comparison group.


Options:
A: Arm Label: Usual care; Type: NO_INTERVENTION; Interventions: N/A | Arm Label: Breathlessness Support Service; Type: EXPERIMENTAL; Interventions: Other: Breathlessness Support Service | Intervention Type: OTHER; Name: Breathlessness Support Service; Assigned to Arm(s): Breathlessness Support Service
B: Arm Label: CHF patients, IVR-Enhanced Care; Type: EXPERIMENTAL; Interventions: Behavioral: IVR-Enhanced Care | Arm Label: COPD patients, IVR-Enhanced Care; Type: EXPERIMENTAL; Interventions: Behavioral: IVR-Enhanced Care | Arm Label: CHF patients, Usual Discharge Care; Type: NO_INTERVENTION; Interventions: N/A | Arm Label: COPD patients, Usual Discharge Care; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: IVR-Enhanced Care; Assigned to Arm(s): CHF patients, IVR-Enhanced Care, COPD patients, IVR-Enhanced Care
C: Arm Label: Control group; Type: NO_INTERVENTION; Interventions: N/A | Arm Label: Self monitoring for patients with COPD; Type: EXPERIMENTAL; Interventions: Procedure: self-monitoring for patients with severe COPD | Arm Label: Nurse monitoring for patients with COPD; Type: EXPERIMENTAL; Interventions: Procedure: nurse-monitoring for patients with severe COPD | Intervention Type: PROCEDURE; Name: self-monitoring for patients with severe COPD; Assigned to Arm(s): Self monitoring for patients with COPD | Intervention Type: PROCEDURE; Name: nurse-monitoring for patients with severe COPD; Assigned to Arm(s): Nurse monitoring for patients with COPD
D: Arm Label: Case Management; Type: EXPERIMENTAL; Interventions: Behavioral: 40 minute standardized education session, Behavioral: Individualized action plan, Behavioral: Individualized care plan, Behavioral: Standardized reinforcement/motivational interviewing and action plan teach-back sessions, Behavioral: Tele-home monitoring, Behavioral: Coordinated and improved communication, Behavioral: Priority access, Behavioral: Dictated patient summary, Behavioral: in-hospital rehabilitation/self-management program, Behavioral: Smoking cessation | Arm Label: Usual care; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Dictated patient summary, Behavioral: in-hospital rehabilitation/self-management program, Behavioral: Smoking cessation, Behavioral: Action plan Respirologist, Behavioral: Web based self management materials | Intervention Type: BEHAVIORAL; Name: 40 minute standardized education session; Assigned to Arm(s): Case Management | Intervention Type: BEHAVIORAL; Name: Individualized action plan; Assigned to Arm(s): Case Management | Intervention Type: BEHAVIORAL; Name: Individualized care plan; Assigned to Arm(s): Case Management | Intervention Type: BEHAVIORAL; Name: Standardized reinforcement/motivational interviewing and action plan teach-back sessions; Assigned to Arm(s): Case Management | Intervention Type: BEHAVIORAL; Name: Tele-home monitoring; Assigned to Arm(s): Case Management | Intervention Type: BEHAVIORAL; Name: Coordinated and improved communication; Assigned to Arm(s): Case Management | Intervention Type: BEHAVIORAL; Name: Priority access; Assigned to Arm(s): Case Management | Intervention Type: BEHAVIORAL; Name: Dictated patient summary; Assigned to Arm(s): Case Management, Usual care | Intervention Type: BEHAVIORAL; Name: in-hospital rehabilitation/self-management program; Assigned to Arm(s): Case Management, Usual care | Intervention Type: BEHAVIORAL; Name: Smoking cessation; Assigned to Arm(s): Case Management, Usual care | Intervention Type: BEHAVIORAL; Name: Action plan Respirologist; Assigned to Arm(s): Usual care | Intervention Type: BEHAVIORAL; Name: Web based self management materials; Assigned to Arm(s): Usual care

Answer: B