***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: Background Geriatric evaluation and management has become st and ard care for community dwelling older adults following an acute admission to hospital . It is unclear whether this approach is beneficial for the frailest older adults living in permanent residential care . This study was undertaken to evaluate ( 1 ) the feasibility and consumer satisfaction with a geriatrician-led supported discharge service for  older adults living in residential care facilities ( RCF ) and ( 2 ) its impact on the uptake of Advanced Care Planning ( ACP ) and acute health care service utilisation . Methods In 2002–4 a r and omised controlled trial was conducted in Melbourne , Australia comparing the geriatrician – led outreach service to usual care for RCF residents . Patients were recruited during their acute hospital stay and followed up at the RCF for six months . The intervention group received a post-discharge home visit within 96 hours , at which a comprehensive geriatric assessment was performed and a care plan developed . Participants and their families were also offered further meetings to discuss ACPs and document Advanced Directives ( AD ) . Additional review s were made available for assessment and management of intercurrent illness within the RCF . Consumer satisfaction was surveyed using a postal question naire . Results The study included 116 participants ( 57 intervention and 59 controls ) with comparable baseline characteristics . The service was well received by consumers demonstrated by higher satisfaction with care in the intervention group compared to controls ( 95 % versus 58 % , p = 0.006).AD were completed by 67 % of participants /proxy decision makers in the intervention group compared to 13 % of RCF residents prior to service commencement . At six months there was a significant reduction in outpatient visits ( intervention 21 ( 37 % ) versus controls 45 ( 76 % ) , ( p < 0.001 ) , but no difference in readmissions rates ( 39 % intervention versus 34 % control , p = 0.6 ) . There was a trend towards reduced hospital bed-day utilisation ( intervention 271 versus controls 372 days ) . Conclusion It is feasible to provide a supported discharge service that includes geriatrician assessment and care planning within a RCF . By exp and ing the service there is the potential for acute health care cost savings by decreasing the dem and for outpatient consultation and further reducing acute care bed-days Objective : To investigate the impact of an in-reach rehabilitation team for patients admitted after road trauma . Design : R and omised control trial of usual care versus early involvement of in-reach rehabilitation team . Telephone follow-up was conducted by a blind assessor at three months for those with minor/moderate injuries and six months for serious/severe injuries . Setting : Four participating trauma services in New South Wales , Australia . Subjects : A total of 214 patients admitted during 2012 - 2015 with a length of stay of at least five days . Intervention : Provision of rehabilitation services in parallel with ward based therapy using an in-reach team for the intervention group . The control group could still access the ward based therapy ( usual care ) . Main measures : The primary outcome was acute length of stay . Secondary outcomes included percentage requiring inpatient rehabilitation , function ( Functional Independence Measure and Timed Up and Go Test ) , psychological status ( Depression Anxiety and Stress Score 21 ) , pain ( Orebro Musculoskeletal Pain Question naire ) and quality of life ( Short Form-12 v2 ) . Results : Median length of stay in acute care was 13 days ( IQR 8 - 21 ) . The intervention group , compared to the control group , received more  physiotherapy and occupational therapy  sessions ( median number of sessions 16.0 versus 11.5 , P=0.003 ) . However , acute length of stay did not differ between the intervention and control groups ( median 15 vs 12 days , P=0.37 ) . There were no significant differences observed in the secondary outcomes at hospital discharge and follow-up . Conclusion : No additional benefit was found from the routine use of acute rehabilitation teams for trauma patients over and above usual care Background Despite growing emphasis on transitional care to reduce costs and improve quality , few studies have examined transitional care improvements in socioeconomically disadvantaged adults . It is important to consider these patients separately as many are high-utilizers , have different needs , and may have different responses to interventions . Objective To evaluate the impact of a multicomponent transitional care improvement program on 30-day readmissions , emergency department ( ED ) use , transitional care quality , and mortality . Design Clustered r and omized controlled trial conducted at a single urban academic medical center in Portl and , Oregon . Participants Three hundred eighty-two hospitalized low-income adults admitted to general medicine or cardiology who were uninsured or had public insurance . InterventionMulticomponent intervention including ( 1 ) transitional nurse coaching and education , including home visits for highest risk patients ; ( 2 ) pharmacy care , including provision of 30 days of medications after discharge for those without prescription drug coverage ; ( 3 ) post-hospital primary care linkages ; ( 4 ) systems integration and continuous quality improvement . Measurements Primary outcomes included 30-day inpatient readmission and ED use . Readmission data were obtained using state-wide administrative data for all participants ( insured and uninsured ) . Secondary outcomes included quality ( 3-item Care Transitions Measure ) and mortality . Research staff administering question naires and assessing outcomes were blinded . Results There was no significant difference in 30-day readmission between C-TraIn ( 30/209 , 14.4 % ) and control patients ( 27/173 , 16.1 % ) , p = 0.644 , or in ED visits between C-TraIn ( 51/209 , 24.4 % ) and control ( 33/173 , 19.6 % ) , p = 0.271 . C-TraIn was associated with improved transitional care quality ; 47.3 % ( 71/150 ) of C-TraIn patients reported a high quality transition compared to 30.3 % ( 36/119 ) control patients , odds ratio 2.17 ( 95 % CI 1.30–3.64 ) . Zero C-TraIn patients died in the 30-day post-discharge period compared with five in the control group ( unadjusted p = 0.02 ) . Conclusions C-TraIn did not reduce 30-day inpatient readmissions or ED use ; however , it improved transitional care quality Background Intermediate care is a health care model developed to optimize the coordination of health care services and functional independence . In Central Norway , an  intermediate care hospital ( ICH )  was established in a municipality to improve hospital discharge and follow-up among elderly patients with chronic conditions and comprehensive care needs . The aim of this study was to investigate the effectiveness of hospital discharges to a municipality with an ICH compared to discharges to a municipality without an ICH . Methods This was a non-r and omized controlled observational study of hospitalized patients aged 60 years and older from two municipalities . Patients ( n = 328 ) admitted to a general hospital from February 2010 through September 2011 were included in the study and followed for 12 months . The data were analyzed using descriptive statistics , analysis of covariance ( ANCOVA ) and Cox proportional hazard regression . Results Each patient discharged from the general hospital to the municipality with an ICH had a shorter length of stay and used on average 4.2 ( p = 0.046 ) fewer hospital days during 1 year compared to patients from the municipality without an ICH . Otherwise , no statistical significant differences were found between the municipalities in terms of hospital readmissions , admissions , mortality , activities of daily living , primary health care utilization or total care days . A post hoc analysis of patients discharged to the ICH compared to the municipality without an ICH , showed that the ICH patients were older and frailer , but the outcome was similar to the main analysis . Conclusions Having an ICH in the municipality facilitated shorter length of hospital stay and kept the risk of readmissions , mortality and post-hospitalization care needs at the same level as without an ICH Background One of the reasons physiotherapy services are provided to emergency departments ( EDs ) and emergency extended care units ( EECUs ) is to review patients ' mobility to ensure they are safe to be discharged home . Aim To investigate whether a physiotherapy service to an EECU altered the rate of hospital admission , rate of re-presentation to the ED , visits to community healthcare practitioners , return to usual work/home/leisure activities and patient satisfaction . Methods A r and omised trial with concealed allocation , assessor blinding and intention-to-treat analysis was undertaken in an EECU . The sample comprised 186 patients ( mean age 70 years , 123 ( 66 % ) female patients , 130 ( 70 % ) trauma ) who were referred for physiotherapy assessment /intervention .  Referral occurred at any stage of the patients ' EECU admission . All participants received medical/nursing care as required . The physiotherapy group also received physiotherapy assessment /intervention . Results The physiotherapy group had a 4 % ( 95 % CI −18 % to 9 % ) lower rate of admission to hospital than the control group and a 4 % ( 95 % CI −6 % to 13 % ) higher rate of re-presentation to the ED , which were statistically non-significant ( p≥0.45 ) . Differences between groups for use of community healthcare re sources , return to usual work/home/leisure activities and satisfaction with their EECU care were small and not significant . Conclusion A physiotherapy service for EECU patients , as provided in this study , did not reduce the rate of hospital admission , rate of re-presentation to the ED , use of community healthcare re sources , or improve the rate of return to usual work/home/leisure activities or patient satisfaction . Trial registration number ANZCTRN12609000106235 IMPORTANCE Hospital readmissions are common and costly , and no single intervention or bundle of interventions has reliably reduced readmissions . Virtual wards , which use elements of hospital care in the community , have the potential to reduce readmissions , but have not yet been rigorously evaluated . OBJECTIVE To determine whether a virtual ward-a model of care that uses some of the systems of a hospital ward to provide interprofessional care for community-dwelling patients -can reduce the risk of readmission in patients at high risk of readmission or death when being discharged from hospital . DESIGN , SETTING , AND PATIENTS High-risk adult hospital discharge patients in Toronto were r and omly assigned to either the virtual ward or usual care .  A total of 1923 patients were r and omized during the course of the study : 960 to the usual care group and 963 to the virtual ward group . The first patient was enrolled on June 29 , 2010 , and follow-up was completed on June 2 , 2014 . INTERVENTIONS Patients assigned to the virtual ward received care coordination plus direct care provision ( via a combination of telephone , home visits , or clinic visits ) from an interprofessional team for several weeks after hospital discharge . The interprofessional team met daily at a central site to design and implement individualized management plans . Patients assigned to usual care typically received a typed , structured discharge summary , prescription for new medications if indicated , counseling from the resident physician , arrangements for home care as needed , and recommendations , appointments , or both for follow-up care with physicians as indicated . MAIN OUTCOMES AND MEASURES The primary outcome was a composite of hospital readmission or death within 30 days of discharge . Secondary outcomes included nursing home admission and emergency department visits , each of the components of the primary outcome at 30 days , as well as each of the outcomes ( including the composite primary outcome ) at 90 days , 6 months , and 1 year . RESULTS There were no statistically significant between-group differences in the primary or secondary outcomes at 30 or 90 days , 6 months , or 1 year . The primary outcome occurred in 203 of 959 ( 21.2 % ) of the virtual ward patients and 235 of 956 ( 24.6 % ) of the usual care patients ( absolute difference , 3.4 % ; 95 % CI , -0.3 % to 7.2 % ; P = .09 ) . There were no statistically significant interactions to indicate that the virtual ward model of care was more or less effective in any of the prespecified subgroups . CONCLUSIONS AND RELEVANCE In a diverse group of high-risk patients being discharged from the hospital , we found no statistically significant effect of a virtual ward model of care on readmissions or death at either 30 days or 90 days , 6 months , or 1 year after hospital discharge . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01108172 Residents of long-term care facilities have highly complex care needs and quality of care is of international concern . Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization . The Residential Aged Care Integration Program ( RACIP ) is a quality improvement intervention to support residential aged care staff and includes on-site support , education , clinical coaching , and care coordination provided by  gerontology nurse specialists ( GNSs ) employed by a large district health board . The effect of the outreach program was evaluated through a r and omized comparison of hospitalization 1 year before and after program implementation . The sample included 29 intervention facilities ( 1,425 residents ) and 25 comparison facilities ( 1,128 residents ) receiving usual care .  Acute hospitalization rate unexpectedly increased for both groups after program implementation , although the rate of increase was significantly less for the intervention facilities . The hospitalization rate after the intervention increased 59 % for the comparison group and 16 % for the intervention group ( rate ratio ( RR ) = 0.73 , 95 % confidence interval ( CI ) 
    Output:
    
Mixed results were found regarding the effectiveness of many types of interventions .
Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission .
Successful pre- and post-discharge interventions focused on multidisciplinary approaches .
Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction .
Existing systematic review s on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance .
The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care , multidisciplinary service provision , individualization of services , discharge planning initiated in hospital and specialist follow-up