***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: CONTEXT Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients , but the benefits of more intensive follow-up of hospitalized elders at risk for poor outcomes after discharge has not been studied . OBJECTIVE To examine the effectiveness of an advanced practice nurse-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions .  DESIGN R and omized clinical trial with follow-up at 2 , 6 , 12 , and 24 weeks after index hospital discharge . SETTING Two urban , academically affiliated hospitals in Philadelphia , Pa. PARTICIPANTS Eligible patients were 65 years or older , hospitalized between August 1992 and March 1996 , and had 1 of several medical and surgical reasons for admission . INTERVENTION Intervention group patients received a comprehensive discharge planning and home follow-up protocol design ed specifically for elders at risk for poor outcomes after discharge and implemented by advanced practice nurses . MAIN OUTCOME MEASURES Readmissions , time to first readmission , acute care visits after discharge , costs , functional status , depression , and patient satisfaction . RESULTS A total of 363 patients ( 186 in the control group and 177 in the intervention group ) were enrolled in the study ; 70 % of intervention and 74 % of control subjects completed the trial . Mean age of sample was 75 years ; 50 % were men and 45 % were black . By week 24 after the index hospital discharge , control group patients were more likely than intervention group patients to be readmitted at least once ( 37.1 % vs 20.3 % ; P<.001 ) . Fewer intervention group patients had multiple readmissions ( 6.2 % vs 14.5 % ; P = .01 ) and the intervention group had fewer hospital days per patient ( 1.53 vs 4.09 days ; P<.001 ) . Time to first readmission was increased in the intervention group ( P<.001 ) . At 24 weeks after discharge , total Medicare reimbursements for health services were about $ 1.2 million in the control group vs about $ 0.6 million in the intervention group ( P<.001 ) . There were no significant group differences in post-discharge acute care visits , functional status , depression , or patient satisfaction . CONCLUSIONS An advanced practice nurse-centered discharge planning and home care intervention for at-risk hospitalized elders reduced readmissions , lengthened the time between discharge and readmission , and decreased the costs of providing health care . Thus , the intervention demonstrated great potential in promoting positive outcomes for hospitalized elders at high risk for rehospitalization while reducing costs OBJECTIVES To study the feasibility and effectiveness of a  discharge planning intervention . DESIGN Quasi-experimental pre-post study design . SETTING General medicine wards at three hospitals : an academic medical center , a community teaching hospital , and a community-based nonteaching hospital . PARTICIPANTS All patients aged 65 and older admitted to the hospitalist services . INTERVENTION The intervention toolkit had five core elements : admission form with geriatric cues , facsimile to the primary care provider , interdisciplinary worksheet to identify barriers to discharge , pharmacist-physician collaborative medication reconciliation , and predischarge planning appointments . MEASUREMENTS Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge . Odds ratios were determined , and site effects were examined accordig to interaction terms and Breslow Day statistics . RESULTS Two hundred thirty-seven patients were followed during the preintervention period , and 185 were exposed to the intervention . Patients characteristics were similar across the two time periods . The proportion of patients with high- quality transitions home , measured according to Coleman 's Care Transition Measures , increased from 68 % to 89 % ( odds ratio (OR)=3.49 , 95 % confidence interval (CI)=2.06 - 5.92 ) . Return to the emergency department within 3 days of discharge was lower in the intervention period ( 10 % vs 3 % , OR=0.25 , 95 % CI=0.10 - 0.62 ) . At 30 days , there was a lower rate of readmission ( 22 % vs 14 % , OR=0.59 , 95 % CI=0.34 - 0.97 ) and fewer visits to the emergency department ( 21 % vs 14 % , OR=0.61 , 95 % CI=0.36 - 1.03 ) ( P=.06 ) . CONCLUSION When hospitalized elderly patients are treated with consideration of their specific needs , healthcare outcomes can be improved BACKGROUND among elderly patients , readmission in the month following hospital discharge is a frequent occurrence which involves a risk of functional decline , particularly among frail subjects . While previous studies have identified risk factors of early readmission , geriatric syndromes , as markers of frailty have not been assessed as potential predictors . OBJECTIVE to evaluate the risk of early unplanned readmission , and to identify predictors in in patients aged 75 and over , admitted to medical wards through emergency departments . DESIGN prospect i ve multi-centre study . SETTING nine French hospitals . SUBJECTS one thous and three hundred and six medical in patients , aged 75 and older admitted through emergency departments ( SAFES cohort ) . METHODS using logistic regressions , factors associated with early unplanned re-hospitalisation ( defined as first unplanned readmission in the thirty days after discharge ) were identified using data from the first week of hospital index stay obtained by comprehensive geriatric assessment . RESULTS data from a thous and out of 1,306 in patients were analysed . Early unplanned readmission occurred in 14.2 % of in patients and was not related with sociodemographic characteristics , comorbidity burden or cognitive impairment . Pressure sores ( OR = 2.05 , 95 % CI = 1.0 - 3.9 ) , poor overall condition ( OR = 2.01 , 95 % CI = 1.3 - 3.0 ) , recent loss of ability for self-feeding ( OR = 1.9 , 95 % CI = 1.2 - 2.9 ) , prior hospitalisation during the last 3 months ( OR = 1.6 , 95 % CI = 1.1 - 2.5 ) were found to be risk factors , while sight disorders appeared as negatively associated ( OR = 0.5 , 95 % CI = 0.3 - -0.8 ) . CONCLUSIONS markers of frailty ( poor overall condition , pressure sores , prior hospitalisation ) or severe disability ( for self-feeding ) were the most important predictors of early readmission among elderly medical in patients . Early identification could facilitate preventive strategies in risk group Purpose : The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients ' perceptions of their readiness for hospital discharge .  Design : A correlational , prospect i ve , longitudinal design with path analyses was used to explore relationships among transition theory-related variables . Setting : Midwestern tertiary medical center . Sample : 147 adult medical-surgical patients . Methods : Predictor variables included patient characteristics , hospitalization factors , and nursing practice s that were measured prior to hospital discharge using a study enrollment form , the Quality of Discharge Teaching Scale , and the Care Coordination Scale . Discharge readiness was measured using the Readiness for Hospital Discharge  Scale administered within 4 hours prior to discharge . Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services . Findings : Living alone , discharge teaching ( amount of content received and nurses ' skill in teaching delivery ) , and care coordination explained 51 % of readiness for discharge score variance . Patient age and discharge readiness explained 16 % of variance in postdischarge coping difficulty . Greater readiness for discharge was predictive of fewer readmissions . Conclusions : Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness . Study results provided support for Meleis ' transitions theory as a useful model for conceptualizing and investigating the discharge transition . Implication s for Practice : The study results have implication s for the CNS role in patient and staff education , system building for the postdischarge transition , and measurement of clinical care outcomes The objective of the study was to develop and vali date predictors of 30-day hospital readmission using readily available administrative data and to compare prediction models that use alternate comorbidity classifications . A retrospective cohort study was design ed ; the models were developed in a two-thirds r and om sample and vali date d in the remaining one-third sample . The study cohort consisted of 29,292 adults aged 65 or older who were admitted from July 2002 to June 2004 to any of seven acute care hospitals in the Dallas – Fort Worth metropolitan area affiliated with the Baylor Health Care System . Demographic variables ( age , sex , race ) , health system variables ( insurance , discharge location , medical vs surgical service ) , comorbidity ( classified by the Elixhauser classification or the High-Risk Diagnoses in the Elderly Scale ) , and geographic variables ( distance from patient 's residence to hospital and median income ) were assessed by estimating relative risk and risk difference for 30-day readmission . Population -attributable risk was calculated . Results showed that age 75 or older , male sex , African American race , medical vs surgical service , Medicare with no other insurance , discharge to a skilled nursing facility , and specific comorbidities predicted 30-day readmission . Models with demographic , health system , and either comorbidity classification covariates performed similarly , with modest discrimination ( C statistic , 0.65 ) and acceptable calibration ( Hosmer-Lemeshow ϰ2 = 6.08 ; P > 0.24 ) . Models with demographic variables , health system variables , and number of comorbid conditions also performed adequately . Discharge to long-term care ( relative risk , 1.94 ; 95 % confidence interval , 1.80–2.09 ) had the highest population -attributable risk of 30-day readmission ( 12.86 % ) . A 25 % threshold of predicted probability of 30-day readmission identified 4.1 % of patients ≥65 years old as priority patients for improved discharge planning . We conclude that elders with a high risk of 30-day hospital readmission  can be identified early in their hospital course The problems of  caregivers  are identified as one of the major causes , as well as a preventable one , for the unplanned hospital readmissions of elderly patients . Family caregivers are found to be under intense stress and burden , and to encounter many difficulties preparing themselves , both physically and mentally , for the return home from the hospital of an elderly family member . However , few studies of rehospitalization of the elderly have focused on the point of view of the family caregiver . The purpose of this study was to explore the predictors , especially the needs of the family caregiver , for rehospitalization , within a month after having been discharged , for elderly patients in Taiwan . A prospect i ve , descriptive and correlational study , using 216 elderly patients and their family caregivers from the internal medicine wards of a medical center in Northern Taiwan was conducted . It was found that elderly patients with caregivers requesting help from a support group were 5.3 times more likely to be rehospitalized than those with caregivers that did not request such help . In addition , the odds of rehospitalization for elderly patients with some self-care ability , whose caregiver reported at least one need for social services , was 9.03 ( CI=2.32 - 35.16 ) times that of those whose caregivers reported no need for social services . Based on the findings of this study , health care providers need to assess the self-care ability of their elderly patients . In addition they should assess the need for support groups and social services to caregivers before the hospital discharge of Taiwanese elders , and perhaps other Chinese population s as well BACKGROUND Patients with complex care needs who require care across different health care setting s are vulnerable to experiencing serious quality problems . A care transitions intervention design ed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates . METHODS R and omized controlled trial . Between September 1 , 2002 , and August 31 , 2003 , patients were identified at the time of hospitalization and were r and omized to receive the intervention or usual care .  The setting was a large integrated delivery system located in Colorado . Subjects ( N = 750 ) included community-dwelling adults 65 years or older admitted to the study hospital with 1 of 11 selected conditions . Intervention patients received ( 1 ) tools to promote cross-site communication , ( 2 ) encouragement to take a more active role in their care and to assert their preferences , and ( 3 ) continuity across setting s and guidance from a " transition coach . "  Rates of rehospitalization were measured at 30 , 90 , and 180 days . RESULTS Intervention patients had lower rehospitalization rates at 30 days ( 8.3 vs 11.9 , P = .048 ) and at 90 days ( 16.7 vs 22.5 , P = .04 ) than control subjects . Intervention patients had lower rehospitalization rates for the same condition that precipitated the index hospitalization at 90 days ( 5.3 vs 9.8 , P = .04 ) and at 180 days ( 8.6 vs 13.9 , P = .046 ) than controls . The mean hospital costs were lower for intervention patients ( $ 2058 ) vs controls ( $ 2546 ) at 180 days ( log-transformed P = .049 ) . CONCLUSION Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care trans 
    Output:
    
We found statistically significant results that  caregiver education interventions impact positively on decreasing unplanned readmissions .
This review highlights the dearth of information on the caregiver 's need for specific information on discharge and the need for future research .There is little evidence that education interventions aim ed at caregivers are uniformly effective in decreasing pneumonia readmission rates .
The evidence suggests that a structured education intervention that includes caregivers probably brings about a small reduction in unexpected readmissions within thirty days for elderly patients with community acquired pneumonia .
However , quality of discharge teaching , a key component of coordinated care , is a strong predictor of readiness for discharge and readmission rates .