The purpose of the IMPaCT Transitions program is to help low-income general medicine patients who have been cared for at the Hospital of the University of Pennsylvania or Presbyterian Hospital with the transition from hospital to a primary care clinic. The purpose of IMPaCT Home is to help low-SES patients who have been in the hospital frequently to address the root causes of their poor health. Through the IMPaCT Transitions program, patients are partnered with community health workers who help support them for the two weeks following hospital discharge. In the IMPaCT Home program, patients receive support for three months following hospital discharge. We plan to conduct a QI evaluation of this intervention using two sources: 1) a telephone survey of patients who received IMPaCT as well as matched control patients, 2) open-ended qualitative data from patients who received the IMPaCT intervention.

You may be eligible for this study if you meet the following criteria:

• Conditions: mitral valve insufficiency
• Age: Between 18 Years - 99 Years
• Gender: All