Clinical Research Directory

Inclusion Criteria: * 18 years of age or older * About to be admitted through the ED for one of the NDC diagnoses or a synonym (per Study Protocol document), defined by the presence of a Plan to Admit order or Bed Request order, OR recently admitted under observation or inpatient status for one of the NDC diagnoses. * Identified as at-risk for an avoidable hospitalization in the ED based on a pre-determined set of lab and vital parameters. * Insurance that authorizes the patient to follow-up at UCLA Health, or self-pay * Admitted or being admitted to an internal medicine service Exclusion Criteria: * Heart or lung transplant recipient with concern for graft dysfunction * Pregnant * Enrolled in hospice * Admitted to a critical care service * ED deems discharge unsafe due to complex social or medical factors * Active malignant cancer (per Council of State and Territorial Epidemiologists value set) * Pulmonary arterial hypertension (per Joint Commission value set) * Undergoing workup for solid organ transplant * Interstitial lung disease (including pulmonary fibrosis) (per Higher Level 7 value set) * Requiring inpatient procedure or surgery defined by the presence of an anesthesia event or operating room encounter. * The ED deems discharge unsafe due to complex social or medical factors. * Transferred to an ineligible hospital Note: The Health System plans to limit the volume of referrals to the NDC by only referring patients who have an even birth date (this is more equitable than first-come-first-serve, because wage workers are more likely to come to the ED later in the day; even/odd birth date theoretically keeps more spots open for patients presenting to the ED later).