***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture . Design : Preplanned sub analysis of r and omised intervention study . Settting : Jyväskylä Central Hospital , Finl and . Participants : 243 independently living patients aged 65 years or older admitted to hospital with hip fracture . Intervention : After surgery patients in the intervention group ( n=120 ) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals . Main outcome measures : Length of hospital stay , mortality , and place of residence three months and one year after surgery for hip fracture . Results : The median length of hospital stay of hip fracture patients with moderate dementia ( mini mental state examination score 12 - 17 ) was 47 days in the intervention group ( n=24 ) and 147 days in the control group ( n=12 , P=0.04 ) . The corresponding figures for patients with mild dementia ( score 18 - 23 ) were 29 days in the intervention group ( n=35 ) and 46.5 days in the control group ( n=42 , P=0.002 ) . Three months after the operation , in the intervention group 91 % ( 32 ) of the patients with mild dementia and 63 % ( 15 ) of the patients with moderate dementia were living independently . In the control group , the corresponding figures were 67 % ( 28 ) and 17 % ( 2 ) . There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores . Conclusions : Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation Background The incidence of hip fracture is expected to increase during the coming years , dem and ing greater re sources and improved effectiveness on this group of patients . The aim of the present study was to evaluate the effectiveness of an  integrated care pathway ( ICP ) in patients with an acute fracture of the hip . Methods A nonr and omized prospect i ve study comparing a consecutive series of patients treated by the conventional pathway to a newer intervention . 112 independently living patients aged 65 years or older admitted to the hospital with a hip fracture were consecutively selected . Exclusion criteria were pathological fracture and severe cognitive impairment . An ICP was developed with the intention of creating a care path with rapid pre-operative attention , increased continuity and an accelerated training programme based on the individual patient 's prerequisites and was used as a guidance for each patient 's tailored care in the intervention group ( N = 56 ) The main outcome measure was the length of hospital stay . Secondary outcomes were the amount of time from the emergency room to the ward , to surgery and to first ambulation , as well as in-hospital complications and 30-day readmission rate . Results The intervention group had a significantly shorter length of hospital stay ( 12.2 vs. 26.3 days ; p < 0.000 ) , a shorter time to first ambulation ( 41 vs. 49 h ; p = 0.01 ) , fewer pressure wounds ( 8 vs. 19 ; p = 0.02 ) and medical complications ( 5 vs. 14 ; p = 0.003 ) than the comparison group . No readmissions occurred within 30 days post-intervention in either group . Conclusion Implementing an ICP for patients with a hip fracture was found to significantly reduce the length of hospital stay and improve the quality of care The purpose of the current study was to evaluate the effectiveness of a multidisciplinary Hip Fracture Service in the treatment of hip fractures in elderly patients . Baseline information and hospital outcomes were compared for 510 patients over the age of 65 with hip fracture treated before and after the institution of the Hip Fracture Service .  Data included basic demographic data , admission laboratory results , surgical information , number of comorbidities , mortality , medical complications , discharge information , time to surgery , and length of stay in hospital . The demographics of the two groups of patients were similar . Patients treated as part of the Hip Fracture Service had fewer medical complications ( 36 % vs. 51 % ) , more often had surgery within 24 hours ( 63 % vs. 35 % ) , and had shorter hospital stays ( mean , 5.7 days vs. 8.1 days ) than patients treated before the Hip Fracture Service . These findings provide the rationale for a prospect i ve , r and omized trial of the service OBJECTIVES To evaluate the incremental cost in the year after hip fracture . DESIGN Prospect i ve cohort study . SETTING Baltimore , Maryl and . PARTICIPANTS 759 community dwelling older patients who sustained a hip fracture and participated in the Baltimore Hip Fracture Study . MEASUREMENTS Re source use for direct medical care , formal nonmedical care , and informal care in the 6 months before and the year after fracture was estimated from interviews with patients or proxy respondents .  Costs in 1993 dollars were estimated by multiplying re sources times national unit cost estimates . RESULTS The annualized costs in the year before the fracture ranged between $ 18,523 and $ 20,928 . The costs in the year after the fracture equaled $ 37,250 . The incremental costs in the year after the fracture , compared with the costs in the year before the fracture , ranged between $ 16,322 and $ 18,727 . The largest cost differences were attributable to hospitalizations , nursing home stays , and rehabilitation services . CONCLUSIONS Because we compared the costs after a fracture with costs before , our estimates of the incremental cost of a hip fracture are lower than others in the literature . These results , obtained from interviews with patients enrolled in a cohort study , or their proxies , provide the best data available to date on the economic cost of hip fractures among community-dwelling older persons In recent years , intense pressures to reduce the costs of health care have led many health care organizations to seek strategies that reduce re source utilization while maintaining the quality of care [ 1 - 5 ] . Among the most popular of the methods intended to meet this challenge are critical pathways . Critical pathways are management plans that display goals for patients and provide the corresponding ideal sequence and timing of staff actions to achieve those goals with optimal efficiency [ 6 - 8 ] . Interest in critical pathways has increased tremendously during the past several years as early anecdotal reports of their cost-saving potential have been disseminated , usually outside the peer- review ed medical literature [ 7 , 9 , 10 ] . The rapid push for critical pathway implementation comes from intense competitive pressures and the persistent evidence of unexplained variation in medical practice [ 11 , 12 ] . Many managed care organizations have added their weight to this process by m and ating certain critical pathways or seeking partner hospitals that are willing to develop their own [ 7 ] . However , no controlled study has shown a critical pathway to reduce the duration of hospital stay or to decrease re source use , nor has any study shown critical pathways to improve patient satisfaction or outcomes [ 13 ] . Nevertheless , like other promising medical technologies , critical pathways are being disseminated before controlled trials have been done to evaluate their effectiveness . Despite the lack of data , an increasing number of physicians will be asked to participate in critical pathway development . Even more will find that their hospitalized patients are already on pathways that they may or may not have endorsed . To enhance the effectiveness of critical pathways and minimize the disruption to the patientphysician relationshipphysicians and other caregivers must underst and the origin , potential benefits , and potential pitfalls of this new method . Critical Pathways : A New Form of Clinical Guideline Critical pathways have varying formats and are known by many names , including critical paths , clinical pathways , and care paths . Interpreted formally , a critical pathway is the sequence of events in a process that takes the greatest length of time . Like the techniques of continuous quality improvement , critical pathway techniques were first developed for use in industry as a tool to identify and manage the rate-limiting steps in production processes [ 14 - 17 ] . First developed in the 1950s , the Critical Path Method was frequently linked with a similar approach , the Program Evaluation and Review Technique , to coordinate multiple contractors or persons in a project by identifying the key sequence of events , or critical path , the requirements of which would drive the timeline of the overall project [ 18 , 19 ] . Critical pathway techniques have subsequently been applied to projects as diverse as construction , civil engineering , town planning , marketing , ship building , product design , and equipment installation [ 6 ] . Critical pathways were first developed and applied to health care in the 1980s , when prospect i ve payment systems focused greater interest on potential methods to improve hospital efficiency [ 6 ] . Most of the first critical pathways in hospitals were developed by nurses for nursing care alone [ 20 , 21 ] , but multidisciplinary teams soon began developing pathways to encompass all aspects of care for hospitalized patients [ 22 - 24 ] . In general , efforts to develop critical pathways in health care have not incorporated the formal techniques used by industrial predecessors to identify the true critical pathway in any care process [ 18 , 25 ] . Instead , when critical pathways are used to plan medical care , the specific goals usually include the following : 1 . Selecting a best practice when practice styles vary unnecessarily . 2 . Defining st and ards for the expected duration of hospital stay and for the use of tests and treatments . 3 . Examining the interrelations among the different steps in the care process to find ways to coordinate or decrease the time spent in the rate-limiting steps . 4 . Giving all hospital staff a common game plan from which to view and underst and their various roles in the overall care process . 5 . Providing a framework for collecting data on the care process so that providers can learn how often and why patients do not follow an expected course during their hospitalization . 6 . Decreasing nursing and physician documentation burdens . 7 . Improving patient satisfaction with care by educating patients and their families about the plan of care and involving them more fully in its implementation . The general format of critical pathway guidelines is the Gantt chart , which outlines the suggested patient care process based on a time-task matrix , listing the components of care in one column and cross-aligning these entries with columns pertaining to time [ 8 ] . Figure 1 is an example of such a chart for a critical pathway for patients who have had coronary artery bypass graft surgery . Categories of multidisciplinary staff actions are listed in the first column of the pathway , with specific actions for each day of hospitalization . As indicated in Figure 1 , a patient 's diet is expected to progress successfully from ice chips to clear liquids on the first day after surgery . For all other categories of patient care , critical pathways likewise explicitly mark the transition points of patient progress and lay out a coordinated map of staff activities to achieve those transitions in the most efficient way possible . Figure 1 . The first 2 days of a simplified critical pathway for patients who have had cardiac surgery .  Critical pathways differ from most clinical guidelines , protocol s , and algorithms in several key respects . First , clinical guidelines often address the appropriateness of care by delineating the indications for tests or treatments . Critical pathways , on the other h and , have almost always focused on the quality and efficiency of care after decisions have already been made to admit the patient or perform the procedure . Another way in which critical pathways differ from most clinical guidelines is that they are multidisciplinary in their development and in the scope of their implementation . Critical pathways are also design ed along specific timelines , sometimes even in hour-by-hour detail , for indicated actions , and pathways not only spell out these specific actions but also enumerate expected intermediate patient outcomes that serve as checkpoints for the performance of both the patient and the pathway . Yet another distinguishing feature of critical pathways is that their comprehensive design allows them to be used as a part of the patient record , often replacing other documentation entirely [ 6 , 24 ] . All staff interventions and intermediate clinical outcomes that occur as expected can be simply initialed on the critical pathway document . If staff actions or intermediate patient outcomes do not occur as expected , however , a variance from the pathway is said to have occurred [ 26 ] . Variances , too , can be noted on the document , along with an explanation of their cause or causes , and , if needed , a plan can be described to return the patient to the expected course of treatment and outcomes . Critical Pathway Development Topic Selection Critical pathways are typically developed for the hospital care associated with high-volume , high-cost diagnoses and procedures , particularly those for which inefficient variation in the process of care is thought to exist [ 6 ] . Surgical procedures , such as coronary artery bypass graft surgery and total hip replacement , lend themselves particularly well to critical pathways because the care process differs relatively little from patient to patient . For this same reason , obstetric procedures such as normal vaginal delivery and cesarean section have also been subjects of pathways in many institutions [ 24 ] . For most medical diagnoses , however , patient care has proved more difficult to translate successfully into critical pathways because of the greater heterogeneity among patients and problems [ 6 , 27 ] . Some institutions have reported that pathways fail when used for medical patients who have either multiple problems and therefore multiple relevant pathways or a problem that does not fit neatly within any single st and ardized pathway [ 27 - 29 ] . Despite these concerns , however , pathways have been design ed and implemented at many institutions for medical diagnoses such as myocardial infa rct ion , stroke , and deep venous thrombosis [ 23 ] . Team Composition The group that is organized to develop a critical pathway should be multidisciplinary in order to bring to the table the knowledge and perspectives that are necessary to view the care process in its entirety . Although many institutions have appointed nurses as the leaders of critical pathway teams [ 6 ] , we have found that having a physician-expert lead each team lends credibility to the pathways and builds a foundation of support among all clinicians . Each pathway team should also have a group facilitator from the hospital administration , a housestaff physician , a member of the quality management department who has expertise in critical pathway methods , and a community-based primary care phys 
    Output:
    
There were wide differences among the studies that assessed the effects of CPs on HF patients , with some contrasting clinical outcomes reported .
Secondary studies that were non-specific for CPs and included other multidisciplinary care approaches as well showed , in some cases , a shorter hospital length of stay ( LOS ) compared to usual care ; studies that focused on promoting early mobilization showed better outcomes of mortality , morbidity , function , or service utilization ;  CPs mainly based on intensive occupational therapy and /or physical therapy exercises  improved functional recovery and reduced LOS , with patients also discharged to a more favorable discharge destination ; CPs principally focused on early mobilization improved functional recovery .
A secondary study specifically design ed for CPs showed lower odds of experiencing common complications of hospitalization after HF .