***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 
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    Input: 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 determine whether a new multimodal comprehensive discharge-planning intervention would reduce emergency rehospitalizations or emergency department ( ED ) visits for very old in patients . DESIGN Six-month prospect i ve , r and omized ( Zelen design ) , parallel-group , open-label trial . SETTING Six acute geriatric units ( AGUs ) in Paris and its surroundings . PARTICIPANTS Six hundred sixty-five consecutive in patients aged 70 and older ( intervention group ( IG ) n = 317 ; control group ( CG ) n = 348 ) . INTERVENTION Intervention-dedicated geriatricians different from those in the study centers implemented the intervention , which targeted three risk factors for preventable readmissions and consisted of three components : comprehensive chronic medication review , education on self-management of disease , and detailed transition-of-care communication with outpatient health professionals . MEASUREMENTS Emergency hospitalization or ED visit 3 and 6 months after discharge , as assessed by telephone calls to the participant , the caregiver , and the general practitioner and confirmed with the hospital administrative data base . RESULTS Twenty-three percent of IG participants were readmitted to hospital or had an ED visit 3 months after discharge , compared with 30.5 % of CG participants ( P = .03 ) ; at 6 months , the proportions were 35.3 % and 40.8 % , respectively ( P = .15 ) . Event-free survival was significantly higher in the IG at 3 months ( hazard ratio ( HR ) = 0.72 , 95 % confidence interval ( CI ) = 0.53 - 0.97 , P = .03 ) but not at 6 months ( HR = 0.81 , 95 % CI = 0.64 - 1.04 , P = .10 ) . CONCLUSION This intervention was effective in reducing rehospitalizations and ED visits for very elderly participants 3 but not 6 months after their discharge from the AGU . Future research should investigate the effect of this intervention of transitional care in a larger population and in usual acute and subacute geriatric care BACKGROUND Since in hospitalized older patients delirium is associated with poor outcomes , we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium . METHODS We studied 852 patients 70 years of age or older who had been admitted to the general-medicine service at a teaching hospital . Patients from one intervention unit and two usual-care units were enrolled by means of a prospect i ve matching strategy . The intervention consisted of st and ardized protocol s for the management of six risk factors for delirium : cognitive impairment , sleep deprivation , immobility , visual impairment , hearing impairment , and dehydration . Delirium , the primary outcome , was assessed daily until discharge . RESULTS Delirium developed in 9.9 percent of the intervention group as compared with 15.0 percent of the usual-care group , ( matched odds ratio , 0.60 ; 95 percent confidence interval , 0.39 to 0.92 ) . The total number of days with delirium ( 105 vs. 161 , P=0.02 ) and the total number of episodes ( 62 vs. 90 , P=0.03 ) were significantly lower in the intervention group . However , the severity of delirium and recurrence rates were not significantly different . The overall rate of adherence to the intervention was 87 percent , and the total number of targeted risk factors per patient was significantly reduced . Intervention was associated with significant improvement in the degree of cognitive impairment among patients with cognitive impairment at admission and a reduction in the rate of use of sleep medications among all patients . Among the other risk factors per patient there were trends toward improvement in immobility , visual impairment , and hearing impairment . CONCLUSIONS The risk-factor intervention strategy that we studied result ed in significant reductions in the number and duration of episodes of delirium in hospitalized older patients . The intervention had no significant effect on the severity of delirium or on recurrence rates ; this finding suggests that primary prevention of delirium is probably the most effective treatment strategy OBJECTIVE To test the impact of a geriatric evaluation and management model on the costs of acute hospital management of emergently admitted older adults . DESIGN R and omized controlled trial . Patients were followed in the acute hospital from admission through discharge . Results based on both univariate and multiple regression analyses . SETTING Private , nonprofit , academic medical center in a densely populated urban area . PATIENTS Adults 70 years of age and older admitted from the Emergency Department to the medicine service ( non-ICU admission ) who did not have an internist on staff at the admitting hospital . Of 141 r and omized patients , 111 ( 78.7 % ) met eligibility criteria . INTERVENTION Assignment of a geriatrician and a social worker as the primary managing team during the hospital stay . MAIN OUTCOME MEASURES Length of stay , total cost of acute hospital care , cost of laboratory , pharmacy , and rehabilitation services . RESULTS Patients in the intervention group had 2.1 fewer days of hospitalization , but this shorter length of stay was not statistically significant ( P = 0.108 ) . There were no differences in mortality or discharge disposition . In risk-adjusted , multiple regression analysis the intervention group had a statistically significant lower predicted total cost per patient than the usual care group ( -$2,544 , P = 0.029 ) ; assignment to the intervention group was associated with a lower predicted cost per patient for laboratory ( including cardiology graphics ) services ( P = 0.007 ) and pharmacy costs ( P = 0.047 ) . CONCLUSIONS When controlled for important predictors of expected re source use , care provided by a geriatric management team result ed in a significant reduction in the cost of hospitalization . A reduction in the cost of laboratory , cardiographic , and pharmacy services is consistent with the team 's philosophy of defining the services needed based on goals related to functional outcomes OBJECTIVE To assess outcomes of using a clinical pathway for managing patients with fractured neck of femur . DESIGN Prospect i ve , pseudor and omised , controlled trial . SETTING St Vincent 's Hospital , Melbourne , Victoria ( a tertiary referral , university teaching hospital ) , 1 October 1997 to 30 November 1998 . PARTICIPANTS 111 patients ( 80 women and 31 men ; mean age , 81 years ) admitted via the emergency department with a primary diagnosis of fractured neck of femur . INTERVENTIONS Management guided by a clinical pathway ( 55 patients ) or established st and ard of care ( control group , 56 patients ) . MAIN OUTCOME MEASURES Timing of referrals and discharge planning ; total length of stay ; and complication and readmission rates within 28 days of discharge . RESULTS Patients managed according to the clinical pathway had a shorter total stay ( 6.6 versus 8.0 days ; P = 0.03 ) , even if assessment for placement by the Aged Care Assessment Service was required ( 9.5 versus 13.6 days ; P = 0.03 ) . There were no significant differences in complication and readmission rates between pathway and control patients ( complication rates , 24 % versus 36 % ; P = 0.40 ; readmission rates , 4 % versus 11 % ; P = 0.28 ) . CONCLUSION Coordinated multidisciplinary care of patients with fractured neck of femur reduces length of stay without increasing complications BACKGROUND Older persons frequently experience a decline in function following an acute medical illness and hospitalization . OBJECTIVE To test the hypothesis that a multicomponent intervention , called Acute Care for Elders ( ACE ) , will improve functional outcomes and the process of care in hospitalized older patients . DESIGN R and omized controlled trial . SETTING Community teaching hospital . PATIENTS A total of 1,531 community-dwelling patients , aged 70 or older , admitted for an acute medical illness between November 1994 and May 1997 . INTERVENTION ACE includes a specially design ed environment ( with , for example , carpeting and uncluttered hallways ) ; patient-centered care , including nursing care plans for prevention of disability and rehabilitation ; planning for patient discharge to home ; and review of medical care to prevent iatrogenic illness . MEASUREMENTS The main outcome was change in the number of independent activities of daily living ( ADL ) from 2 weeks before admission ( baseline ) to discharge . Secondary outcomes included re source use , implementation of orders to promote function , and patient and provider satisfaction . RESULTS Self-reported measures of function did not differ at discharge between the intervention and usual care groups by intention-to-treat analysis . The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge ( 34 % vs 40 % ; P = .027 ) and during the year following hospitalization ( P = .022 ) . There were no significant group differences in hospital length of stay and costs , home healthcare visits , or readmissions . Nursing care plans to promote independent function were more often implemented in the intervention group ( 79 % vs 50 % ; P = .001 ) , physical therapy consults were obtained more frequently ( 42 % vs 36 % ; P = .027 ) , and restraints were applied to fewer patients ( 2 % vs 6 % ; P = .001 ) . Satisfaction with care was higher for the intervention group than the usual care group among patients , caregivers , physicians , and nurses ( P < .05 ) . CONCLUSIONS ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital length of stay or costs . A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially beneficial effects on patient outcomes Objective : To determine the feasibility and potential impact of a non-pharmacologic multidisciplinary intervention for reducing hospital readmissions in elderly patients with congestive heart failure . Design : Prospect i ve , r and omized clinical trial , with 2:1 assignment to the study intervention or usual care . Setting : 550-bed secondary and tertiary care university teaching hospital . Patients and participants : 98 patients ≥70 years of age ( mean 79±6 years ) admitted with documented congestive heart failure . Interventions : Comprehensive multidisciplinary treatment strategy consisting of intensive teaching by a geriatric cardiac nurse , a detailed review of medications by a geriatric cardiologist with specific recommendations design ed to improve medication compliance and reduce side effects , early consultation with social services to facilitate discharge planning , dietary teaching by a hospital dietician , and close follow-up after discharge by home care and the study team . Measurements and main results : All patients were followed for 90 days after initial hospital discharge . The primary study endpoints were rehospitalization within the 90-day interval and the cumulative number of days hospitalized during follow-up . The 90-day readmission rate was 33.3 % ( 21.7%–44.9 % ) for the patients receiving the study intervention ( n=63 ) compared with 45.7 % ( 29.2–62.2 % ) for the control patients ( n=35 ) . The mean number of days hospitalized was 4.3±1.1 ( 2.1–6.5 ) for the treated patients vs. 5.7±2.0 ( 1.8–9.6 ) for the usual-care patients . In a prospect ively defined subgroup of patients at intermediate risk for readmission ( n=61 ) , readmissions were reduced by 42.2 % ( from 47.6 % to 27.5 % ; p=0.10 ) , and the average number of hospital days during follow-up decreased from 6.7±32 days to 3.2±1.2 days ( p = NS ) . Conclusions : These pilot data suggest that a comprehensive , multidisciplinary approach to reducing repetitive hospitalizations in elderly patients with congestive heart failure may lead to a reduction in readmissions and hospital days , particularly in patients at moderate risk for early rehospitalization . Further evaluation of this treatment strategy , including an assessment of the cost-effectiveness , is warranted A quantitative systematic review , or meta- analysis , uses statistical methods to combine the results of 
    Output:
    
Conclusions Early discharge planning with acutely admitted older adults improves system level outcomes after index hospital discharge .