***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: A r and omised controlled trial has been conducted into the effects of  discharging patients from hospital either 48 hours or six to seven days after operations for inguinal hernia and varicose veins . There was no statistically significant difference in major postoperative complications between the two lengths of stay for either of the two conditions . Similarly there was no difference between the two groups of hernia patients in relation to eventual recurrences . There was no significant difference in length of convalescence between long-stay and short-stay patients in full-time occupations . The savings to the statutory services of discharging patients early were estimated at 25.72 pounds per patient . Patients appeared to approve of the type of care they experienced , regardless of length of stay . However , the families of short-stay patients were significantly less enthusiastic in their attitudes towards the policy of early discharge than the families of long-stay patients All admissions to a 1,100-bed Department of Veterans Affairs ( VA ) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then r and omly assigned to VA hospital-based team home care ( HBHC , N = 85 ) or customary care ( N = 86 ) .  Patient functioning , and patient and caregiver morale and satisfaction with care were measured at baseline , one month , and six months . Health services utilization was monitored over the six-month study period and converted to cost . Findings included no differences in patient survival , activities of daily living ( ADL ) , cognitive functioning , or morale , but a significant increase in patient ( p = .02 ) and caregiver ( p = .005 ) satisfaction with care at one month . A substitution effect of HBHC was seen . Those in the experimental group used 5.9 fewer VA hospital days ( p = .03 ) , result ing in a $ 1,639 or 47 percent per capita saving in VA hospital costs ( p = .02 ) . As a result , total per capita health care costs , including HBHC , were $ 769 or 18 percent ( n.s . ) lower in the HBHC sample , indicating that expansion of VA HBHC to serve terminally ill veterans would increase satisfaction with care at no additional cost The community health services in Southern Derbyshire , in conjunction with an acute hospital , established a pilot scheme for the early discharge of fractured neck of femur patients from hospital to their own homes . The scheme was evaluated by prospect ively comparing a group of patients using Hospital at Home ( HAH ) and a group receiving hospital care only .  The main outcomes measured were the proportion of hospital admissions for fractured neck of femur using HAH  , length of stay , patient satisfaction , general health status at discharge as measured by the Nottingham Health Profile , and three-month mortality and readmission rates . Costs were calculated based on prices charged by providers of the services . In the first year of the scheme , 76 ( 18 per cent ) of the 432 hospital admissions for fractured neck of femur fitted the selection criteria and agreed to admission to HAH .  Thirty-four patients were identified who were suitable for HAH  but not admitted to it . The comparison of the 76 HAH patients and 34 hospital patients revealed that HAH patients were discharged from hospital an average of 7 days earlier ; patients in both groups were satisfied with the care they received ; the general health status of the two groups at discharge was similar , with the exception that HAH patients had better emotional health on discharge from care ; the three-month mortality rate was similar in both groups ( 5 per cent ) ; the readmission rate for HAH patients appeared higher than for hospital patients but this difference was not statistically significant ( 15.8 per cent versus 8.8 per cent , Fisher 's exact test , p = 0.187 ) . ( ABSTRACT TRUNCATED AT 250 WORDS The purpose of this study was to evaluate the impact of a primary home care intervention program on patient outcomes after selected patients were discharged from a short-stay hospital . R and om assignment of 249 frail , elderly patients was made to a group provided with physician-led primary home care , and home assistance service on a 24-hour basis , or to a control group given st and ard care . At r and omization , patients were considerably disabled , had a mean age of 80.5 years , and had a high likelihood of long-stay hospital care .  Medical and functional data were essentially the same at baseline for both groups . At 6-months follow-up , significant improvement in instrumental activities of daily living ( P = 0.04 ) and outdoor walking ( P = 0.03 ) , and medical condition was found in the primary care intervention group compared with the controls and less utilization of long-stay hospital facilities was displayed in the team patients ( P < 0.001 ) than in the controls . A selection of elderly , dependent patients can be cared for in their homes after short-stay hospital discharge and benefit from this primary home care intervention program in terms of improved medical and functional outcomes and less long-stay hospitalization The rehabilitation of elderly patients after hip fractures is important : we report a prospect i ve study which compares supported home rehabilitation with management in hospital in two similar groups of patients . Our results show that early discharge from  hospital  and  home rehabilitation  produces substantial savings in bed days , and also provides quicker and more effective recovery In a controlled trial of a home-care service available for the first 6 months after acute stroke , 440 patients received the new service and 417 patients were in the control group .  The trial group used more hospital bed days , had a slightly higher admission rate , and did not show better emotional adjustment to stroke than the control group . There was no difference between the 2 groups in stress on relatives . Functional recovery was equal in the 2 groups . A quarter of patients managed at home in each group were severely disabled . Providing a new service does not necessarily alter clinical decisions in the short term , and care should be taken before exp and ing domiciliary services to reduce hospital use The opinions of  patients  and of  caring persons ( usually relatives )  were sought in this trial of different methods of providing care for  360 patients after operations for hernia or varicose veins . Analysis of patients ' opinions suggested that day care was the most acceptable of the three types of care examined . The reactions of caring persons did not reveal any major criticisms or disadvantages Alternative systems of care after operations for varicose veins or hernia were compared in a total of 360 selected patients , of whom 121 were allocated to be managed in an acute ward for 48 h , 122 in a convalescent hospital for 48 h and 117 to be discharged directly home to the care of the district nursing sister and general practitioner .  There were no deaths or major complications . Anaesthetic or surgical problems caused 5 patients ( 3 convalescent and 2 day care ) to be retained in hospital on the day of operation . Minor complications were recorded in approximately one‐third of the patients . The majority of these were effectively dealt with by the district nursing sister and only one‐third of the complications needed the attention of the general practitioner . Two of the ward patients and 1 of the convalescent patients required readmission to hospital ( 1 per cent in all ) . No significant difference was demonstrated in the medical outcome between the three groups after operation . Day care was the most economical of the three systems of care . Inquiry into the patients ' opinions elicited the highest proportion of favourable responses in the day care group The Home Treatment Team ( HTT ) , a hospital discharge team for elderly patients , was created to provide practical help and promote independence of patients at home for up to 6 weeks after hospital discharge . Patients were those judged to be at particular risk of failing to resettle , and thus being readmitted to hospital or admitted to a residential or nursing home . An open r and omized controlled trial compared patients receiving the HTT ( n = 29 ) with controls ( n = 25 ) receiving appropriate conventional community services .  Fewer  HTT  patients were readmitted ( four by 6 weeks and nine by 12 weeks ) than controls ( nine by 6 weeks and 14 by 12 weeks , p < 0.05 ) and more were at home at 6 weeks ( 24 , 83 % and 10 , 40 % , p < 0.05 ) , 12 weeks ( 21 , 72 % and 11 , 44 % , p < 0.05 ) and 12 months ( 17 , 58 % and 10 , 40 % , p < 0.05 ) . The HTT group spent fewer days in hospital than controls during 12 weeks ( median difference 34 days , 95 % confidence interval 0 - 75 , p < 0.05 ) and more days at home during 12 months ( 90 ; 247 - 0 , p = 0.02 ) . Neither group showed any significant change in mental state or functional abilities over 12 weeks . Potentially confounding factors were considered insufficient explanation for the difference in outcome between the groups . It is concluded that the HTT was of benefit but the mechanism of its effect was not identified 
    Output:
    
Patients discharged early from hospital to hospital at home following elective surgery expressed greater satisfaction with care than those who remained in hospital .
Carers , however , expressed less satisfaction with hospital at home compared with hospital care .
No statistically significant difference was detected for overall net health costs .
CONCLUSIONS This review does not support the widespread adoption of hospital at home , nor the discontinuation of existing schemes for elderly medical patients , patients who have had elective surgery , or those with a terminal illness .
There is insufficient evidence to determine the effect of hospital at home on patient outcomes , or cost to the health service