***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: OBJECTIVES Various healthcare interventions have been launched targeting the growing population of older people . The objective of this study was to investigate the of a case management intervention for frail old people ( aged 65 + years ) effects on healthcare utilization . MATERIAL S AND METHODS The study was conducted in a municipality in southern Sweden and included people aged 65 + years who lived in their ordinary homes , were dependent in two or more activities of daily living ( ADL ) , and had at least two hospital admissions , or four physician visits , in the previous year . One-hundred-fifty-three participants were r and omly assigned to either an intervention ( n=80 ) or a control group ( n=73 ) . The one-year intervention comprised home visits , at least once a month , by case managers . Group differences were investigated 6 - 12 and 0 - 6 months before , and 0 - 6 and 6 - 12 months after , baseline . RESULTS The intervention group had , compared to the control group , significant lower mean number ( 0.08 vs. 0.37 , p=0.041 ) and proportion ( 17.4 vs. 46.9 % , p=0.016 ) of ED visits not leading to hospitalization 6 - 12 months after baseline . The intervention group also had a significantly lower mean number of visits to physicians in outpatient care 6 - 12 months after baseline ( 4.09 vs. 5.29 , p=0.047 ) . CONCLUSION The effect on ED visits not leading to hospitalization meant that those in the control group were more likely to visit the ED for reasons that did not require hospitalization , suggesting that they may have been less monitored than the intervention group . The intervention has the potential to reduce the burden on outpatient care and ED Background : The Treatment Fidelity Workgroup ( TFW ) established by the National Institutes of Health provides a 5-point structure for intervention fidelity : dosing , interventionists ' consistency , intervention delivery , receipt , and enactment of the intervention . Using our reflexology trial , we apply the first 3 points . Objectives : Study objectives were to ( 1 ) evaluate key dosage dimensions associated with complementary and alternative medicine ( CAM ) research , ( 2 ) evaluate approaches to interventionists ' consistency of delivery of CAM protocol s , and ( 3 ) evaluate and discuss data that reflect CAM intervention fidelity . Methods : Women with late-stage breast cancer ( N = 318 ) were r and omly assigned to either 4 weeks of reflexology , placebo , or st and ard care . Results : Dosing consists of 3 dimensions : frequency ( 4 sessions ) , duration ( 30 minutes ) , and interval between sessions ( 5 - 9 days ) . Interventionist consistency revealed more than a 90 % accuracy rate in following the protocol ; 84 % and 89 % completion rate of the 4 sessions in the reflexology and placebo groups , respectively ; and no differences in attrition after r and omization between reflexology and placebo groups ( 17 % and 15 % , respectively ) . Intervention delivery , examined through debriefing data , indicated a significantly higher rate of correct guesses on group assignment in the reflexology group as compared with the placebo ( 82 % vs 46 % , P = .0002 ) . Conclusion : This study points out the relevance of dosing , interventionists ' consistency , and delivery data within a CAM clinical trial , as well as the challenges of blinding . Implication s for Practice : Monitoring intervention fidelity by using the key areas identified by the TFW ensures that findings from a clinical trial are meaningful and have the potential to be translated to clinical practice Background A small group of frequent visitors to emergency departments accounts for a disproportional large number of total emergency department visits . Previous interventions in this population have shown mixed results . Objective To determine whether a nurse-managed telephone-based case-management intervention can reduce healthcare utilization and improve self-assessed health status in frequent emergency department users . Methods We carried out a Zelen- design r and omized-controlled trial among patients who were identified as frequent emergency department users ( ≥3 visits during the 6 months before inclusion ) at the Karolinska University Hospital in Stockholm ( Sweden ) . Patients included in the study ( n=268 ) were r and omized to either the intervention group or the control group and followed for 1 year . Patients who declined to participate or could not be reached were also followed for the study outcome . Results The telephone-based case-management intervention  reduced the total number of outpatient visits ( relative risk 0.80 ; 95 % confidence interval 0.75–0.84 ) , the number of emergency department visits ( relative risk 0.77 ; 95 % confidence interval 0.69–0.86 ) , the number of days patients were admitted to hospitals as well as the total healthcare costs for hospital admissions . There was no difference in mortality or other identified adverse outcomes between the intervention and the control groups . Patient self-assessed health status improved for the patients who received the case-management intervention . Conclusion Our results indicate that the nurse-managed telephone-based case-management intervention represents a possible strategy to improve care for frequent emergency department users as well as decrease outpatient visits , admission days and healthcare costs BACKGROUND Although African American adults bear a disproportionate burden from diabetes mellitus ( DM ) , few r and omized controlled trials have tested culturally appropriate interventions to improve DM care . METHODS We r and omly assigned 542 African Americans with type 2 DM enrolled in an urban managed care organization to either an intensive or minimal intervention group . The intensive intervention group consisted of all components of the minimal intervention plus individualized , culturally tailored care provided by a nurse case manager ( NCM ) and a community health worker ( CHW ) , using evidence -based clinical algorithms with feedback to primary care providers ( eg , physicians , nurse practitioners , or physician assistants ) . The minimal intervention consisted of mailings and telephone calls every 6 months to remind participants about preventive screenings . Data on diabetic control were collected at baseline and at 24 months by blind observers ; data emergency department ( ER ) visits and hospitalizations were assessed using administrative data . RESULTS At baseline , participants had a mean age of 58 years , 73 % were women , and 50 % were living in poverty . At 24 months , compared with the minimal intervention group , those in the intensive intervention group were 23 % less likely to have ER visits ( rate difference [ RD ] , -14.5 ; adjusted rate ratio [ RR ] , 0.77 ; 95 % confidence interval [ CI ] , 0.59 - 1.00 ) . In on-treatment analyses , the rate reduction was strongest for patients who received the most NCM and CHW visits ( RD , -31.0 ; adjusted RR , 0.66 ; 95 % CI , 0.43 - 1.00 ; rate reduction downward arrow 34 % ) . CONCLUSION These data suggest that a culturally tailored intervention conducted by an NCM/CHW team reduced ER visits in urban African Americans with type 2 DM . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00022750 Background Pharmacists may improve medication-related outcomes during transitions of care . The aim of the Iowa Continuity of Care Study was to determine if a pharmacist case manager ( PCM ) providing a faxed discharge medication care plan from a tertiary care institution to primary care could improve medication appropriateness and reduce adverse events , rehospitalization and emergency department visits . Methods Design . R and omized , controlled trial of 945 participants assigned to enhanced , minimal and usual care groups conducted 2007 to 2012 . Subjects . Participants with cardiovascular-related conditions and /or asthma or chronic obstructive pulmonary disease were recruited from the University of Iowa Hospital and Clinics following admission to general medicine , family medicine , cardiology or orthopedics . Intervention . The minimal group received admission history , medication reconciliation , patient education , discharge medication list and medication recommendations to inpatient team . The enhanced group also received a faxed medication care plan to their community physician and pharmacy and telephone call 3–5 days post-discharge . Participants were followed for 90 days post-discharge . Main Outcomes and Measures . Medication appropriateness index ( MAI ) , adverse events , adverse drug events and post-discharge healthcare utilization were compared by study group using linear and logistic regression , as models accommodating r and om effects due to pharmacists indicated little clustering . Results Study groups were similar at baseline and the intervention fidelity was high . There were no statistically significant differences by study group in medication appropriateness , adverse events or adverse drug events at discharge , 30-day and 90-day post-discharge . The average MAI per medication as 0.53 at discharge and increased to 0.75 at 90 days , and this was true across all study groups . Post-discharge , about 16 % of all participants experienced an adverse event , and this did not differ by study group ( p > 0.05 ) . Almost one-third of all participants had any type of healthcare utilization within 30 days post-discharge , where 15 % of all participants had a 30-day readmission . Healthcare utilization post-discharge was not statistically significant different at 30 or 90 days by study group . Conclusion The pharmacist case manager did not affect medication use outcomes post-discharge perhaps because quality of care measures were high in all study groups . Trial registration Clinical trials.gov registration : NCT00513903 , August 7 , 2007 OBJECTIVES To determine if post-discharge telephonic case management ( CM ) reduces emergent hospital readmissions for select high-risk patients . STUDY DESIGN Prospect i ve , r and omized . METHODS We conducted a prospect i ve , r and omized control study of the effect of hospital discharge planning from health plan telephonic case managers on readmissions  for high-risk patients . High risk was defined as having an initial discharge major diagnosis of gastrointestinal , heart , or lower respiratory and length of stay of 3 days or more . The intervention group ( N = 1994 ) received telephonic outreach and engagement within 24 hours of discharge and their calls were made in descending risk order to engage the highest risk first . The control group ( N = 1994 ) received delayed telephonic outreach and engagement 48 hours after discharge notification and no call order by risk was applied . Comparison groups had statistically equivalent characteristics at baseline ( P > .05 ) . RESULTS The intent-to-treat 60-day readmission rate for the treatment group was 7.4 % versus 9.6 % for the control group ( P = .01 ) , representing a 22 % relative reduction in all-cause readmissions . Two post hoc assessment s were conducted to identify potential mechanisms of action for this effect and showed that the treatment group had more physician visits and prescription drug fills following initial discharge . CONCLUSIONS Telephonic CM reduces the likelihood of 60-day readmissions for select high-risk patients . This study suggests that prioritizing telephonic outreach to a select group of highrisk patients based on their discharge date and risk severity is an effective case management strategy . Future studies should explore patients ' activity beyond phone calls to further explain the mechanism for readmission reduction Background Fragmentation within health care systems may negatively impact the quality of chronic disease patient care . We sought to evaluate the relationship between care management processes ( CMP ) , integration of services , and blood pressure  (  BP  ) control among diabetic patients . Methods Retrospective chart review s were performed for a r and om sample of adult diabetic hypertensive patients ( n = 2,162 ) from 28 physician organizations in the United States ( US ) . A modified version of the Physician Practice Connection Readiness Survey ( PPC-RS ) was completed by the chief medical officer at each site . The PPC-RS measured health system organization , delivery system re design , decision support , clinical information systems , and self-management support , and an integration scale measured structure , functions , and financial risk . Correlations between PPC and integration scores and BP outcomes were assessed using Spearman correlation coefficients . Results Approximately 39.9 % of diabetic patients had controlled  BP . Mean total PPC score across sites was 55 , with highest mean scores for health system organization ( 81 ) , followed by design support ( 60 ) , clinical information systems ( 57 ) , self-management support ( 39 ) , and delivery system re design ( 39 ) . Mean integration score was 46 ( SD 27 , range 4–93 ) , and means of subscores were 64 for structure , 33 for financial risk , and 42 for function . Clinical information systems subscore was correlated with uncontrolled BP ( r = −0.38 , p < 0.05 ) , while association with total PPC score was strong but not significant at p < 0.05 ( r = −0.32 ) . Total integration score and the structure subscore were significantly correlated with BP control ( r = 0.38 , p < 0.05 , and r = 0.49 , p < 0.01 ) . Conclusions This study suggests that CMP and service integration may be associated with better outcomes in diabetes , though results were mixed and limited by a small number of participating sites . Primary care implementation of integrated electronic medical records may have a beneficial effect on patient outcomes for diabetes and other chronic diseases Background Transition from hospital to home is a critical period for older persons with acute myocardial infa rct ion ( AMI ) .  Home-based secondary prevention programs led by nurses have been proposed to facilitate the patients ’ adjustment to AMI after discharge . The objective of this study was to evaluate the effects of a nurse-based case management for elderly patients discharged after an AMI 
    Output:
    
Analysis of the studies showed that case management greatly reduced hospital readmissions and emergency department visits .
There was strong evidence of significant reductions in hospital use with case management as an intervention .