***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 BACKGROUND Few investigators have targeted elderly patients and monitored outcomes of care in studies on discharge planning interventions after critical illness . OBJECTIVES To pilot test an intensive care unit-based nursing screening intervention to assist in determining the discharge needs and outcomes of critically ill elderly patients . METHOD A r and omized clinical trial with in-hospital and mailed question naires was used . Patients 65 years and older who were hospitalized in 1 of 2 intensive care units at 2 midwestern university-affiliated medical centers were recruited for the study .  Control patients ( n = 53 ) received usual discharge planning , experimental patients ( n = 47 ) were screened in the intensive care unit by using the Discharge Planning Question naire . Both groups were assessed for readiness for discharge when discharged from the hospital and were followed up 2 weeks later with a survey completed at home . RESULTS One hundred patients 65 to 90 years old ( mean 73 , SD 5.78 ) completed the study . Sixty-six percent were men . The 2 groups did not differ with regard to age , race , sex , severity of illness , lengths of stay in the intensive care unit or hospital , education level , or income . Patients in the experimental group were more ready than patients in the control group for discharge ( P = .06 ) . Patients in the experimental group were also more likely to report they had adequate information , had less concern about managing their care at home , knew their medicines , and knew danger signals indicating potential complications . CONCLUSION Intensive care unit-based early discharge planning can affect elderly patients ' preparation for discharge OBJECTIVES to investigate the effectiveness of a  pharmacy discharge plan  in elderly hospitalized patients . DESIGN r and omized controlled trial . SUBJECTS AND SETTING S we r and omized patients aged 75 years and older on four or more medicines who had been discharged from three acute general and one long-stay hospital to a pharmacy intervention or usual care . INTERVENTIONS the hospital pharmacist developed discharge plans which gave details of medication and support required by the patient . A copy was given to the patient and to all relevant professionals and carers . This was followed by a domiciliary assessment by a community pharmacist . In the control group , patients were discharged from hospital following st and ard procedures that included a discharge letter to the general practitioner listing current medications . OUTCOMES the primary outcome was re-admission to hospital within 6 months . Secondary outcomes included the number of deaths , attendance at hospital outpatient clinics and general practice and proportion of days in hospital over the follow-up period , together with patients ' general well-being , satisfaction with the service and knowledge of and adherence to prescribed medication . RESULTS we recruited 362 patients , of whom 181 were r and omized to each group . We collected hospital and general practice data on at least 91 and 72 % of patients respectively at each follow-up point and interviewed between 43 and 90 % of the study subjects . There were no significant differences between the groups in the proportion of patients re-admitted to hospital between baseline and 3 months or 3 and 6 months . There were no significant differences in any of the secondary outcomes . CONCLUSIONS we found no evidence to suggest that the co-ordinated hospital and community pharmacy care discharge plans in elderly patients in this study influence outcomes The evidence -based medicine ( EBM ) related concepts of hierarchy of evidence , meta-analyses , confidence intervals , study design , etc . are nowadays so widespread , that clinicians willing to use today 's medical literature with underst and ing have no choice but to become familiar with EBM principles and method ologies . Although surgeons may perceive that evidence -based medicine m and ates a strict adherence to r and omised trials , it more accurately involves informed and effective use of all types of evidence ( from meta- analysis of r and omised trials to individual case series and case reports . With the ever-increasing amount of available information , surgeons must consider a shift in paradigm from traditional practice to one that involves question formulation , validity assessment of available studies and appropriate application of research evidence to individual patients OBJECTIVE to prove the effectiveness of geriatric evaluation and management for elderly , hospitalized patients , combined with post-discharge home intervention by an interdisciplinary team . DESIGN r and omized controlled trial with outcome and costs assessed for 12 months after the date of admission . SETTING university-affiliated geriatric hospital and the homes of elderly patients . SUBJECTS 545 patients with acute illnesses admitted from home to the geriatric hospital . INTERVENTIONS patients were r and omly assigned to receive either comprehensive geriatric assessment and post-discharge home intervention ( intervention ) , comprehensive geriatric assessment alone ( assessment ) or usual care . MAIN OUTCOME MEASURES survival , functional status , rehospitalization , nursing home placement and direct costs over 12 months . RESULTS the intervention group showed a significant reduction in length of hospital stay ( 33.49 days vs 40.7 days in the assessment group and 42.7 days in the control group ; P < 0.05 ) and rate of immediate nursing home placement ( 4.4 % vs 7.3 % and 8.1 % ; P < 0.05 ) . There was no difference in survival , acute care hospital readmissions or new admissions to nursing homes but the intervention group had significantly shorter hospital readmissions ( 22.2 days vs 34.2 days and 35.7 days ; P < 0.05 ) and nursing home placements ( 114.7 days vs 161.6 days and 170.0 days ; P < 0.05 ) . Direct costs were lower in the intervention group [ about DM 7000 ( US $ 4000 ) per person per year ] . Functional capacities were significantly better in the intervention group . CONCLUSIONS comprehensive geriatric assessment in combination with post-discharge home intervention does not improve survival , but does improve functional status and can reduce the length of the initial hospital stay and of subsequent readmissions . It can reduce the rate of immediate nursing home admissions and delay permanent nursing home placement . It may also substantially reduce direct costs of hospitalized patients OBJECTIVE To determine the effect of a home-based intervention ( HBI ) on the frequency of unplanned readmission and out-of-hospital death among patients discharged home from acute hospital care . DESIGN A r and omized controlled trial comparing HBI with usual care ( UC ) . SETTING A tertiary referral hospital servicing the northwestern region of Adelaide , South Australia . PARTICIPANTS Medical and surgical patients ( n = 762 ) discharged home after hospitalization . INTERVENTION Home-based intervention ( n = 381 ) consisted of counseling of all patients before discharge followed by a single home visit ( by a nurse and pharmacist ) to those patients considered to be at high risk of readmission ( n = 314 ) in order to optimize compliance with and knowledge of the treatment regimen , identify early clinical deterioration , and intensify follow-up of such patients where appropriate . MEASUREMENTS The primary endpoint was the number of unplanned readmissions plus out-of-hospital deaths over a 6-month follow-up period . RESULTS During the study follow-up , the major endpoint occurred most commonly in the UC group ( 217 vs 155 episodes : P < .001 ) . Overall , the HBI group demonstrated fewer unplanned readmissions ( 154 vs 197 : P = .022 ) , out-of-hospital deaths ( 1 vs. 20 : P < .001 ) , total deaths ( 12 vs. 29 : P = .006 ) , emergency department attendances ( 236 vs 314 : P < .001 ) , and total days of hospitalization ( 1452 vs 1766 : P < .001 ) . There was a disproportionate reduction in multiple events among HBI patients ( P = .035 ) . Hospital-based costs of health care during study follow-up tended to be lower in the HBI group ( $ A2190 vs $ A2680 per patient : P = .102 ) . Mean cost of HBI was $ A190 per patient visited , whereas other community-based health care costs were similar for both groups . CONCLUSIONS Among high-risk patients discharged from acute hospital care , HBI is beneficial in limiting unplanned readmissions and reducing risk of out-of-hospital death . It may be particularly cost-effective if applied selectively to patients with a history of frequent unplanned hospital admission STUDY OBJECTIVE : We determine the cost-effectiveness of a 2-stage emergency department intervention in addition to usual ED care compared with that of usual care alone . METHODS The intervention comprises 2 steps : ( 1 ) identification of high-risk patients by using a screening tool and ( 2 ) a brief st and ardized nursing assessment to identify unresolved problems , followed by referral to an appropriate community provider . The patient population was composed of individuals aged 65 years and older to be released from the EDs of 4 Montreal hospitals . Patients were r and omized by day of ED visit . The perspective of the study is societal , including patients , caregivers , and the formal health care ( government-funded ) system . Outcomes , measured from r and omization to 4 months after r and omization , included ( 1 ) functional decline , as measured by an activities of daily living instrument , or death , and ( 2 ) changes in depressive symptoms . Costs include post-ED care , including hospitalization , physician services , community care , outpatient drugs , and patient and caregiver costs . Cost items were measured with administrative data bases and self-reported question naires . Unit costs for these items were either province-wide rates or else were estimated directly by using provider data . Cost-effectiveness is assessed in qualitative terms , such that outcomes and costs are compared separately . RESULTS The intervention was associated with a reduced rate of functional decline ( including death ) at 4 months . There was no effect of the intervention on change in the patient 's depressive symptoms at 4 months relative to baseline . The estimated ratio of overall costs per patient in the intervention versus the control group , adjusted for covariates , was 0.94 ( 95 % credible interval 0.75 to 1.17 ) . Among patients who had visited the ED during the 30 days before the index visit , the ratio was 0.66 ( 95 % credible interval 0.44 to 0.97 ) . CONCLUSION In this study setting , the intervention is preferred over usual care because beneficial functional outcomes were observed , and overall societal costs were no higher than if usual care only was given The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning . The purpose of this study was to investigate the effectiveness of a  discharge planning protocol  in identifying elderly patients ' home care needs . The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older . The control group received the usual hospital discharge planning protocol . In the experimental group , nurse/social worker teams coordinated the discharge planning process , using an adapted form of the Discharge Planning Question naire ( DPQ ) to identify the home care needs of elderly patients 
    Output:
    
Large effects were noted for patient satisfaction , while moderate effects were evident for patients ' quality of life and readmission rates .