***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: An evaluation was undertaken on the effectiveness and efficiency of care coordination as a means of delivering health services to Australian veterans with a diagnosis of congestive heart failure . The veterans participated in a r and omized controlled trial of care coordination that was supported by the Department of Veterans ' Affairs ( DVA ) . Of 490 veterans who were recruited , 409 were surveyed at baseline ( 214 in the intervention group and 195 controls ) . At follow-up , 288 were surveyed ( 155 intervention and 133 controls ) . Information on cost of care and quality of life ( QOL ) was collected before the commencement of coordinated care and at follow-up after 12 months . Cost of care data were obtained from DVA records . Information on QOL was obtained from telephone interviews , using the Short Form ( SF-12 ) Health Survey and the EuroQol Group EQ-5D survey . There were no significant differences in costs of care between the intervention ( coordinated care ) and control groups of veterans . Nor were there significant differences between the intervention and control groups in QOL measurements with either of the evaluation tools that were used . Because evidence of benefit from coordinated care may be slow to emerge in patients with chronic disease , it would be desirable for future work in this area to include long term , good quality comparative studies on selected veteran population s. Such studies should measure QOL and economic outcomes in addition to clinical indicators BACKGROUND Case management is believed to promote continuity of care and decrease hospitalization rates , although few controlled trials have tested this approach . OBJECTIVE To assess the effectiveness of a st and ardized telephonic case-management intervention in decreasing re source use in patients with chronic heart failure . METHODS A r and omized controlled clinical trial was used to assess the effect of telephonic case management on re source use .  Patients were identified at hospitalization and assigned to receive 6 months of intervention ( n = 130 ) or usual care ( n = 228 ) based on the group to which their physician was r and omized .  Hospitalization rates , readmission rates , hospital days , days to first rehospitalization , multiple readmissions , emergency department visits , inpatient costs , outpatient re source use , and patient satisfaction were measured at 3 and 6 months . RESULTS The heart failure hospitalization rate was 45.7 % lower in the intervention group at 3 months ( P = .03 ) and 47.8 % lower at 6 months ( P = .01 ) . Heart failure hospital days ( P = .03 ) and multiple readmissions ( P = .03 ) were significantly lower in the intervention group at 6 months . Inpatient heart failure costs were 45.5 % lower at 6 months ( P = .04 ) . A cost saving was realized even after intervention costs were deducted . There was no evidence of cost shifting to the outpatient setting . Patient satisfaction with care was higher in the intervention group . CONCLUSIONS The reduction in hospitalizations , costs , and other re source use achieved using st and ardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches Background — The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown . Methods and Results — The effects of a nurse-led , multidisciplinary , home-based intervention ( HBI ) in a typically elderly cohort of patients with chronic heart failure initially r and omized to either HBI ( n=149 ) or usual postdischarge care ( UC ) ( n=148 ) after a short-term hospitalization were studied for up to 10 years of follow-up ( minimum 7.5 years of follow-up ) . Study end points were all-cause mortality , event-free survival ( event was defined as death or unplanned hospitalization ) , recurrent hospital stay , and cost per life-year gained . Median survival in the HBI cohort was almost twice that of UC ( 40 versus 22 months ; P<0.001 ) , with fewer deaths overall ( HBI , 77 % versus 89 % ; adjusted relative risk , 0.74 ; 95 % CI , 0.53 to 0.80 ; P<0.001 ) . HBI was associated with prolonged event-free survival ( median , 7 versus 4 months ; P<0.01 ) . HBI patients had more unplanned readmissions ( 560 versus 550 ) but took 7 years to overtake UC ; the rates of readmission ( 2.04±3.23 versus 3.66±7.62 admissions ; P<0.05 ) and related hospital stay ( 14.8±23.0 versus 28.4±53.4 days per patient per year ; P<0.05 ) were significantly lower in the HBI group . HBI was associated with 120 more life-years per 100 patients treated compared with UC ( 405 versus 285 years ) at a cost of $ 1729 per additional life-year gained when we accounted for healthcare costs including the HBI . Conclusions — In altering the natural history of chronic heart failure relative to UC ( via prolonged survival and reduced frequency of recurrent hospitalization  ) , HBI is a remarkably cost- and time-effective strategy over the longer term Background —It is not known to what extent initially observed benefits of postdischarge programs of care for patients with chronic congestive heart failure ( CHF ) in respect to event-free survival , readmissions , and healthcare costs persist in the long term . Methods and Results —We prospect ively studied the long-term effects of a multidisciplinary home-based intervention ( HBI ) in a cohort of CHF patients r and omly allocated to either to HBI ( n=149 ) or usual care ( n=148 ) . During a median of 4.2 years of follow-up , there were significantly fewer primary end points ( unplanned readmission or death ) in the HBI versus usual care group : a mean of 0.21 versus 0.37 primary events per patient per month ( P < 0.01 ) . Median event-free survival was more prolonged in the HBI than usual care group ( 7 versus 3 months;P < 0.01 ) . Fewer HBI patients died ( 56 % versus 65%;P = 0.06 ) and had more prolonged survival ( a median of 40 versus 22 months;P < 0.05 ) compared with usual care . Assignment to HBI was both an independent predictor of event-free survival ( RR 0.70;P < 0.01 ) and survival alone ( RR 0.72;P < 0.05 ) . Overall , HBI patients had 78 fewer unplanned readmissions compared with usual care ( 0.17 versus 0.29 readmissions per patient per month;P < 0.05 ) . The median cost of these readmissions was $ A325 versus $ A660/month per HBI and usual care patient ( P < 0.01 ) . Conclusions —The beneficial effects of HBI in reducing frequency of unplanned readmissions in CHF patients persist in the long term and are associated with prolongation of survival BACKGROUND Although beta-blockers are routinely prescribed at hospital discharge after myocardial infa rct ion ( MI ) , patients ' adherence has been shown to decline substantially over time . We sought to test the hypothesis that a simple , direct-to-patient intervention can improve adherence to beta-blocker therapy following MI . METHODS We conducted a cluster r and omized controlled trial in 4 geographically dispersed health maintenance organizations testing the hypothesis that a simple direct-to-patient intervention could improve adherence . The study was carried out from June 2004 to March 2005 . The primary analyses were based on 836 post-MI patients who were dispensed a beta-blocker prescription after discharge . The intervention consisted of 2 mailings 2 months apart describing the importance of beta-blocker use . The main outcomes were proportion of days covered with beta-blocker therapy and percentage of patients with at least 80 % of days covered in the 9 months after the first mailing . Analyses were adjusted for age , sex , total medications dispensed , days between MI and intervention , and intervention site . RESULTS Over the entire follow-up period , patients in the treatment arm had a mean absolute increase of 4.3 % of days covered per month compared with patients in the control arm ( a 5.7 % relative change from baseline ) , representing 1.3 extra days ( P = .04 ) . Treatment patients were 17 % more likely ( relative risk , 1.17 ; 95 % confidence interval , 1.02 - 1.29 ) to have 80 % of days covered . For every 16 patients receiving the intervention , 1 additional patient would become adherent ( 80 % or more days covered per month ) . CONCLUSION A low-cost , easily replicable effort to increase adherence can have a demonstrable impact on beta-blocker adherence following MI . Trial Registration clinical trials.gov Identifier : NCT00211172 OBJECTIVES We sought to determine whether a multidisciplinary outpatient management program decreases  chronic heart failure ( CHF )  hospital readmissions and mortality over a six-month period . BACKGROUND Hospital admission for CHF is an important problem amenable to improved outpatient management . METHODS Two hundred patients hospitalized with CHF at increased risk of hospital readmission were r and omized to a multidisciplinary program or usual care . A study cardiologist and a CHF nurse evaluated each patient and made recommendations to the patient 's primary physician before r and omization . The intervention team consisted of a cardiologist , a CHF nurse , a telephone nurse coordinator and the patient 's primary physician . Contact with the patient was on a prespecified schedule . The CHF nurse followed an algorithm to adjust medications . Patients in the nonintervention group were followed as usual . The primary outcome was the composite of the number of CHF hospital admissions and deaths over six months , compared by using a log transformation t test by intention-to-treat analysis . RESULTS The median age of the study patients was 63.5 years , and 39.5 % were women . There were 43 CHF hospital admissions and 7 deaths in the intervention group , as compared with 59 CHF hospital admissions and 13 deaths in the nonintervention group ( p = 0.09 ) . The quality -of-life score , percentage of patients on target vasodilator therapy and percentage of patients compliant with diet recommendations were significantly better in the intervention group . Cost per patient , in 1998 U.S. dollars , was similar in both groups . CONCLUSIONS This study demonstrates that a six-month , multidisciplinary approach to CHF management can improve important clinical outcomes at a similar cost in recently hospitalized high-risk patients with CHF BACKGROUND Multidisciplinary care ( MDC ) of heart failure ( HF ) can significantly reduce rates of unplanned hospitalisation , the major cost component of HF care . AIMS This prospect i ve , r and omised , controlled study examines the cost- benefits of MDC of HF in the setting of optimal medical care . METHODS 98 NYHA class IV HF patients ( mean age 70.8+/-10.5 years ) were r and omised to MDC ( n=51 ) or routine care ( RC ; n=47 ) of HF . A  direct intervention cost was calculated from contact time ( scheduled and unscheduled ) spent by the MDC team . Unplanned hospitalisation costs for HF were calculated at a daily rate of 242 . Outcomes were determined in monetary terms , i.e. the cost of the service per hospitalisation prevented and net costs/savings at 3 months . RESULTS The direct intervention cost of the MDC team was 5860 , with an average cost per patient of 113 ( 95 % Cl : 97 - 128 ) . At 3 months , there were a total of 12 unplanned HF readmissions in the RC group ( 25.5 % rate , 195 days ) compared to 2 in the MDC group ( 3.9 % rate , 17 days ) . The number needed to treat to prevent one hospitalisation for HF was 6 over 3 months . The cost of the service per hospitalisation prevented was 586 . The intervention produced a net cost saving of 37,216 for 51 patients treated over 3 months . Sensitivity analyses using 50 % variation in costs and lower relative risk reductions confirmed the cost- benefits of the intervention . CONCLUSION MDC of HF remains cost-beneficial when combined with optimal , medical care . The significant clinical and cost- benefits suggest that this intensive approach to MDC and medical management should become the st and ard of care for HF Background —Because of the prevalence and expense of congestive heart failure ( CHF ) , significant efforts have been made to develop disease management ( DM ) programs that will improve clinical and financial outcomes . The effectiveness of such programs in a large , heterogeneous population of CHF patients remains unknown . Methods and Results —We r and omized 1069 patients ( aged 70.9±10.3 years ) with systolic ( ejection fraction 35±9 % ) or echocardiographically confirmed diastolic heart failure ( HF ) to assess telephonic DM over an 18-month period . Data were collected at baseline and at 6-month intervals . Survival analysis was performed by Kaplan-Meier and Cox regression methods . Healthcare utilization was defined after extensive record review , with an attempt to account for all inpatient and outpatient visits , medications , and diagnostic tests . We obtained data on 92 % of the patients , from nearly 53 000 health-related encounters . Total cost per patient was defined by adding estimated costs for the observed encounters , excluding the cost of the DM . Kaplan-Meier analysis showed that DM patients had a reduced mortality rate ( P=0.037 ) , with DM patients surviving an average of 76 days longer than controls . Subgroup analysis showed that DM had beneficial 
    Output:
    
Interventions that reduced hospital admissions tended to result in favorable cost outcomes , moderated by increased re source use , intervention cost and /or the durability of the intervention effect .
Overall , none of the study , patient or intervention characteristics appeared to independently influence the cost-effectiveness of a HF-MP .
Conclusion : The extent that HF-MPs reduce hospital readmissions appears to be associated with favorable cost outcomes .
The current evidence does not provide a sufficient evidence base to explain what intervention or clinical attributes may influence the cost implication