Please select the eligibility criteria that correspond to the clinical trial below.
Title: Testing the Re-Engineered Hospital Discharge
Brief Summary: The purpose of this study is to determine if the "Re-Engineered Discharge" will decrease rehospitalization rates and adverse events of patients leaving Boston Medical Center.


Options:
A: Inclusion Criteria:

* hospitalized on one of seven inpatient treatment teams
* uninsured or low-income publicly insured (Medicaid; Medicare/Medicaid; or Medicare without supplemental insurance and ≤200% poverty level)
* reside in one of three metro-area counties (Multnomah, Washington, Clackamas)

Exclusion Criteria:

* not community dwelling (ie not from a long-term care facility or with plans to discharge to skilled nursing facility)
* no access to a working telephone (participants could list a friend or shelter phone)
* non-English speakding
* HIV positive (HIV+ patients were eligible for overlapping transitional care resources)
* disabling mental illness (as characterized by active psychosis or active suicidal ideation) or severe cognitive deficits
* plans to enter hospice.
B: Inclusion Criteria:

The Project Director will meet with the subject to determine if the patient meets inclusion or exclusion criteria.

Inclusion criteria include are patients who:

1. are over 18 years old;
2. are to be discharged to a community, non-institutionalized setting;
3. report that they desire to be hospitalized in the future if there is a clinical need; and
4. are admitted to Firm B of the BMC Inpatient Service.

Exclusion Criteria:

1. admitted to non-general Medical services at BMC (e.g., orthopedic surgery, obstetrics and gynecology, otolaryngology, general surgery, or psychiatry);
2. requiring hospice, nursing home or other institutional settings upon discharge,
3. who die during the admission,
4. subjects who speak languages other than English;
5. those who indicate that they have no access to a telephone or unable to give a contact telephone number; and
6. those not competent to sign informed consent.
C: Inclusion Criteria:

* Age 18 years or older
* Index hospitalization for congestive heart failure or chronic obstructive pulmonary disease
* Access to telephone

Exclusion Criteria:

* Cognitive impairment
* Resident of a nursing home
* Does not speak English
D: Inclusion Criteria:

* Speaks either English or Spanish
* Willing to obtain all long-term prescriptions from one community pharmacy during the 90-day study period
* Diagnosed with at least one of the following conditions: high blood pressure, hyperlipidemia, heart failure, coronary artery disease, heart attack, stroke, transient ischemic attack, asthma, chronic obstructive pulmonary disease (COPD), diabetes, or receiving oral anticoagulation therapy
* Admitted to the general medicine, family medicine, cardiology, or orthopedics services hospital department

Exclusion Criteria:

* Does not have a working telephone
* Has a hearing impairment that does not allow the use of a telephone
* Enrolled in Iowa Care (i.e., individual has no community physician or community pharmacist following hospital discharge)
* Life expectancy estimated at less than 6 months at the time of study entry
* Dementia or cognitive impairment
* Severe psychiatric or psychosocial factors, including substance abuse, that may impair the desire or ability to complete all aspects of the study
* Admission to the psychiatric, surgery, or hematology/oncology services hospital department

Answer: B