***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: Nurses at the Well-Being Institute , a community-based nursing outreach clinic in Detroit , Michigan , located 75 women living with HIV , mental illness , and substance abuse who were lost to follow-up at their HIV medical clinic as part of a nursing research study . Women who had been scheduled for an appointment in the last 4 months but who had missed that appointment were considered " lost to follow-up " in the HIV clinic . The purpose of the research was to study factors related to health care access in women not participating in regular health care for their HIV infection . Women were r and omly assigned to two study groups . Women assigned to " care as usual " study group ( n = 37 ) received no additional services beyond study interviews for 1 year . Women assigned to the " nursing intervention " group ( n = 38 ) were provided with nursing services design ed to facilitate their return to and continued connection with their HIV clinic . Findings showed that factors related to the women 's vulnerability , such as mental illness and drug use , were more related to their use of expensive health care services such as hospital emergency departments or hospital inpatient admissions than was assignment to either the " nursing intervention " or " care as usual " study groups . Two case studies describing the cost of care for 2 of the multiply diagnosed women in the study is presented . The women differed on whether they had stable housing and were accessing care for their mental illness Background Antiretroviral therapy has changed the natural history of human immunodeficiency virus ( HIV ) infection in developed countries , where it has become a chronic disease . This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals . Methodology We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients . This was called Virtual Hospital . We report the results of a prospect i ve r and omised study performed over two years , comparing st and ard care received by HIV-infected patients with Virtual Hospital care . HIV-infected patients with access to a computer and broadb and were r and omised to be monitored either through Virtual Hospital ( Arm I ) or through st and ard care at the day hospital ( Arm II ) . After one year of follow up , patients switched their care to the other arm . Virtual Hospital offered four main services : Virtual Consultations , Telepharmacy , Virtual Library and Virtual Community . A technical and clinical evaluation of Virtual Hospital was carried out . Findings Of the 83 r and omised patients , 42 were monitored during the first year through Virtual Hospital  ( Arm I ) and 41 through st and ard care  ( Arm II ) . Baseline characteristics of patients were similar in the two arms . The level of technical satisfaction with the virtual system was high : 85 % of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system . Neither clinical parameters [ level of CD4 + T lymphocytes , proportion of patients with an undetectable level of viral load ( p = 0.21 ) and compliance levels > 90 % ( p = 0.58 ) ] nor the evaluation of quality of life or psychological question naires changed significantly between the two types of care . Conclusions Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients . Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection . Trial Registration Clinical -Trials.gov : NCT01117675 Imprisonment provides opportunities for the diagnosis and successful treatment of HIV , however , the benefits of antiretroviral therapy are frequently lost following release due to suboptimal access and utilization of health care and services . In response , some have advocated for development of intensive case-management interventions spanning incarceration and release to support treatment adherence and community re-entry for HIV-infected releasees . We conducted a r and omized controlled trial of a motivational Strengths Model bridging case management intervention ( BCM ) beginning approximately 3 months prior to and continuing 6 months after release versus a st and ard of care prison-administered discharge planning program ( SOC ) for HIV-infected state prison inmates . The primary outcome variable was self-reported access to post-release medical care . Of the 104 inmates enrolled , 89 had at least 1 post-release study visit . Of these , 65.1 % of BCM and 54.4 % of SOC assigned participants attended a routine medical appointment within 4 weeks of release ( P > 0.3 ) . By week 12 post-release , 88.4 % of the BCM arm and 78.3 % of the SOC arm had at attended at least one medical appointment ( P = 0.2 ) , increasing in both arms at week 24–90.7 % with BCM and 89.1 % with SOC ( P > 0.5 ) . No participant without a routine medical visit by week 24 attended an appointment from weeks 24 to 48 . The mean number of clinic visits during the 48 weeks post release was 5.23 ( SD = 3.14 ) for BCM and 4.07 ( SD = 3.20 ) for SOC ( P > 0.5 ) . There were no significant differences between arms in social service utilization and re-incarceration rates were also similar . We found that a case management intervention bridging incarceration and release was no more effective than a less intensive pre-release discharge planning program in supporting health and social service utilization for HIV-infected individuals released from prison PURPOSE To evaluate the effects of a collaborative case management intervention for patients with poorly controlled type 2 diabetes on glycemic control , intermediate cardiovascular outcomes , satisfaction with care , and re source utilization . METHODS We conducted a r and omized controlled trial at two Department of Veterans Affairs Medical Centers involving 246 veterans with diabetes and baseline hemoglobin A(1C ) ( HbA(1C ) ) levels > or=7.5 % . Two nurse practitioner case managers worked with patients and their primary care providers , monitoring and coordinating care for the intervention group for 18 months through the use of telephone contacts , collaborative goal setting , and treatment algorithms . Control patients received educational material s and usual care from their primary care providers . RESULTS At the conclusion of the study , both case management and control patients remained under poor glycemic control and there was little difference between groups in mean exit HbA(1C ) level ( 9.3 % vs. 9.2 % ; difference = 0.1 % ; 95 % confidence interval : -0.4 % to 0.7 % ; P = 0.65 ) . There was also no evidence that the intervention result ed in improvements in low-density lipoprotein cholesterol level or blood pressure control or greater intensification in medication therapy . However , intervention patients were substantially more satisfied with their diabetes care , with 82 % rating their providers as better than average compared with 64 % of patients in the control group ( P = 0.04 ) . CONCLUSION An intervention of collaborative case management did not improve key physiologic outcomes for high-risk patients with type 2 diabetes . The type of patients targeted for intervention , organizational factors , and program structure are likely critical determinants of the effectiveness of case management . Health systems must underst and the potential limitations before expending substantial re sources on case management , as the expected improvements in outcomes and downstream cost savings may not always be realized Abstract A case management approach to support services was developed in a Toronto-based AIDS service organization ( ASO ) in Canada to support people living with HIV/AIDS ( PLHAs ) whose needs could not be addressed through usual self-directed access to services . It was therefore important to determine which PLHAs would benefit most from case management .  New clients and those who had been receiving support services from an ASO were r and omized to receive either self-directed use of support services or self-directed care plus strengths-based case management for a six-month period . Results indicated that those who benefited most from case management were very depressed at baseline . Strengths-based case management compared to usual self-directed care markedly improved the physical , social and mental health function of very depressed PLHAs , and reduced their risk behaviours . In addition , the case management participants ’ use of community services was associated with an economically important , though not statistically significant , $ 3,300 per person per annum lower expenditure for the use of all direct health and social services . Although more research is warranted , this research demonstrates that ASOs and funders ought to seriously consider implementing a case management approach to practical assistance for PLHAs with depression Computers are steadily being incorporated in clinical practice . We conducted a nonr and omised , controlled , prospect i ve trial of electronic messages design ed to enhance adherence to clinical practice guidelines . We studied 126 physicians and nurse practitioners who used electronic medical records when caring for 349 patients with HIV infection in a primary care practice . We analysed the response times of clinicians to the situations that triggered alerts and reminders , the number of ambulatory visits , and hospitalisation . The median response times to 303 alerts in the intervention group and 388 alerts in the control group were 11 and 52 days ( p < 0.0001 ) , respectively . The median response time to 432 reminders in the intervention group was 114 days and that for 360 reminders in the control group was over 500 days ( p < 0.0001 ) . There was no effect on visits to the primary care practice . There was , however , a significant increase in the rate of visits outside the primary care practice ( p = 0.02 ) , which is explained by the increased frequency of visits to ophthalmologists . There were no differences in admission rates ( p = 0.47 ) , in admissions for pneumocystosis ( p = 0.09 ) , in visits to the emergency ward ( p = 0.24 ) , or in survival ( p = 0.19 ) . We conclude that the electronic medical record was effective in helping clinicians adhere to practice guidelines Objectives : To assess whether community-based care delivered by people living with HIV/AIDS ( PLWAs ) could replace clinic-based HIV care . Design : Prospect i ve cluster r and omized controlled clinical trial . Setting : Villages surrounding 1 rural clinic in western Kenya . Subjects : HIV-infected adults clinical ly stable on antiretroviral therapy ( ART ) . Intervention : The intervention group received monthly Personal Digital Assistant supported home assessment s by PLWAs with clinic appointments every 3 months . The control group received st and ard of care monthly clinic visits . Main Outcomes Measured : Viral load , CD4 count , Karnofsky score , stability of ART regimen , opportunistic infections , pregnancies , and number of clinic visits . Results : After 1 year , there were no significant intervention-control differences with regard to detectable viral load , mean CD4 count , decline in Karnofsky score , change in ART regimen , new opportunistic infection , or pregnancy rate . Intervention patients made half as many clinic visits as did controls ( P < 0.001 ) . Conclusions : Community-based care by PLWAs result ed in similar clinical outcomes as usual care but with half the number of clinic visits . This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective community-based care to PLWAs , expediting ART rollout and increasing access to treatment while exp and ing the capacity of health care institutions in re source -constrained environments BACKGROUND Identification of new ways to increase access to antiretroviral therapy in Africa is an urgent priority . We assessed whether home-based HIV care was as effective as was facility-based care . METHODS We undertook a cluster-r and omised equivalence trial in Jinja , Ug and a. 44 geographical areas in nine strata , defined according to ratio of urban and rural participants and distance from the clinic , were r and omised  to home-based or facility-based care by drawing sealed cards from a box . The trial was integrated into normal service delivery . All patients with WHO stage IV or late stage III disease or CD4-cell counts fewer than 200 cells per microL who started antiretroviral therapy between Feb 15 , 2005 , and Dec 19 , 2006 , were eligible , apart from those living on isl and s. Follow-up continued until Jan 31 , 2009 . The primary endpoint was virological failure , defined as RNA more than 500 copies per mL after 6 months of treatment . The margin of equivalence was 9 % ( equivalence limits 0.69 - 1.45 ) . Analyses were by intention to treat and adjusted for baseline CD4-cell count and study stratum . This trial is registered at http://is rct n.org , number IS RCT N 17184129 . FINDINGS 859 patients ( 22 clusters ) were r and omly assigned to home and 594 ( 22 clusters ) to facility care . During the first year , 93 ( 11 % ) receiving home care and 66 ( 11 % ) receiving facility care died , 29 ( 3 % ) receiving home and 36 ( 6 % ) receiving facility care withdrew , and 8 ( 1 % ) receiving home and 9 ( 2 % ) receiving facility care were lost to follow-up . 117 of 729 ( 16 % ) in home care had virological failure versus 80 of 483 ( 17 % ) in facility care : rates per 100 person-years were 8.19 ( 95 % CI 6.84 - 9.82 ) for home and 8.67 ( 6.96 - 10.79 ) for facility care ( rate ratio [ RR ] 1.04 , 0.78 - 1.40 ; equivalence shown ) . Two patients from each group were immediately lost to follow-up . Mortality rates were similar between groups ( 0.95 [ 0.71 - 1.28 ] ) . 97 of 857 ( 11 % ) patients in home and 75 of 592 ( 13 % ) 
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This review concludes that case management interventions were most consistently associated with improvements in immunological outcomes but case management demonstrates no clear association with other outcome measures .
The same mixed results were also identified for multidisciplinary and multi-faceted care interventions .
No firm conclusions can be reached about the impact of any one intervention on patient mortality