Charged home. the hospital, ays after dis- sed on deter- rification of Table 1. Characteristics of Study Participants n, implement port that may Intervention Control of appropri- Group, Group Characteristic n = 52 up telephone n = 52 P-Value plished during Age, mean 69.7 70.0 83 me visit was Female, % 55.8 55.8 sharing their African American,% 90 87 51 s provided for Annual income, $ 20,000 -20,000 management. Charlson comorbidity 1.79 1.77 94 score, mean cipants deter- Age-corrected Charlson 5.33 5.44 poor caregiver comorbidity score, mean ement. In such Prior healthcare utilization characteristics the number of 30-day prior readmission 15 20 up calls contin- rates if indicated by 365-day prior readmission 14 45 good support rates int. Thirty-four 365-day prior emergency 48 46 department visit rates w-up through 365-day prior outpatient id the 14-day utilization rates Comorbidities,%% Diabetes mellitus 9014 Congestive heart failure 1 1.5 19.2 130 Coronary artery disease 11.5 173 te of nonelective Hypertension 6.9 69 2 Stroke 3.8 1 15 0, and 365 days Dementia 15.4 on during which Chronic kidney disease 21 1 andary outcomes