***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: Objective : To investigate the lifelong health effects , costs , and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting . Study Design and Methods : Economic evaluation from a healthcare perspective with lifetime horizon alongside a nonr and omized , controlled , before-after study in the Netherl and s. Analyses were based on 1861 diabetes patients in 6 intervention and 9 control regions , representing 37 general practice s and 13 out-patient clinics . Change in the United Kingdom Prospect i ve Diabetes Study score , remaining lifetime , and costs per quality -adjusted life year gained were calculated . Probabilistic life tables were constructed using the United Kingdom Prospect i ve Diabetes Study risk engine , a vali date d diabetes model , and nonparametric bootstrapping of individual patient data . Results : Annual United Kingdom Prospect i ve Diabetes Study risk scores reduced for cardiovascular events ( hazard ratio : 0.83 and 0.98 ) and cardiovascular mortality ( hazard ratio : 0.78 and 0.88 ) for men and women , respectively . Life expectancy improved by 0.97 and 0.76 years for men and women , and quality -adjusted life years by 0.44 and 0.37 , respectively . Higher life expectancy in the intervention group increased lifelong costs by & OV0556;860 for men and & OV0556;645 for women . Initial program costs were about & OV0556;22 per patient . The incremental costs per quality -adjusted life year were & OV0556;1937 for men and & OV0556;1751 for women compared with usual care costs . There is a probability > 95 % that the collaborative is cost-effective , using a threshold of & OV0556;20,000 per quality -adjusted life year . Conclusion : Optimizing integrated and patient-centered diabetes care through a quality -improvement collaborative is cost-effective compared with usual care An evaluation was undertaken on the effectiveness and efficiency of care coordination as a means of delivering health services to Australian veterans with a diagnosis of congestive heart failure . The veterans participated in a r and omized controlled trial of care coordination that was supported by the Department of Veterans ' Affairs ( DVA ) . Of 490 veterans who were recruited , 409 were surveyed at baseline ( 214 in the intervention group and 195 controls ) . At follow-up , 288 were surveyed ( 155 intervention and 133 controls ) . Information on cost of care and quality of life ( QOL ) was collected before the commencement of coordinated care and at follow-up after 12 months . Cost of care data were obtained from DVA records . Information on QOL was obtained from telephone interviews , using the Short Form ( SF-12 ) Health Survey and the EuroQol Group EQ-5D survey . There were no significant differences in costs of care between the intervention ( coordinated care ) and control groups of veterans . Nor were there significant differences between the intervention and control groups in QOL measurements with either of the evaluation tools that were used . Because evidence of benefit from coordinated care may be slow to emerge in patients with chronic disease , it would be desirable for future work in this area to include long term , good quality comparative studies on selected veteran population s. Such studies should measure QOL and economic outcomes in addition to clinical indicators Abstract Background World-wide healthcare systems are faced with an epidemic of type 2 diabetes . In the United Kingdom , clinical care is primarily provided by general practitioners ( GPs ) rather than hospital specialists . Intermediate care clinics for diabetes ( ICCD ) potentially provide a model for supporting GPs in their care of people with poorly controlled type 2 diabetes and in their management of cardiovascular risk factors . This study aims to ( 1 ) compare patients with type 2 diabetes registered with practice s that have access to an ICCD service with those that have access only to usual hospital care ; ( 2 ) assess the cost-effectiveness of the intervention ; and ( 3 ) explore the views and experiences of patients , health professionals and other stakeholders . Methods / Design This two-arm cluster r and omized controlled trial ( with integral economic evaluation and qualitative study ) is set in general practice s in three UK Primary Care Trusts . Practice s are r and omized to one of two groups with patients referred to either an  ICCD ( intervention ) or to hospital care ( control ) . Intervention group : GP practice s in the intervention arm have the opportunity to refer patients to an ICCD - a multidisciplinary team led by a specialist nurse and a diabetologist . Patients are review ed and managed in the ICCD for a short period with a goal of improving diabetes and cardiovascular risk factor control and are then referred back to practice .or Control group : St and ard GP care , with referral to secondary care as required , but no access to ICCD .  Participants are adults aged 18 years or older who have type 2 diabetes that is difficult for their GPs to control . The primary outcome is the proportion of participants reaching three risk factor targets : HbA1c ( ≤7.0 % ) ; blood pressure ( < 140/80 ) ; and cholesterol ( < 4 mmol/l ) , at the end of the 18-month intervention period . The main secondary outcomes are the proportion of participants reaching individual risk factor targets and the overall 10-year risks for coronary heart disease(CHD ) and stroke assessed by the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) risk engine . Other secondary outcomes include body mass index and waist circumference , use of medication , reported smoking , emotional adjustment , patient satisfaction and views on continuity , costs and health related quality of life . We aim ed to r and omize 50 practice s and recruit 2,555 patients . Discussion Forty-nine practice s have been r and omized , 1,997 patients have been recruited to the trial , and 20 patients  have been recruited to the qualitative study . Results will be available late 2012.Trial registration [ Clinical Trials.gov : Identifier NCT00945204 Objective : To assess the cost effectiveness and cost effectiveness acceptability of symptom control delivered by shared care ( SCSC ) and aggressive treatment delivered in hospital ( ATH ) for established rheumatoid arthritis ( RA ) . Methods : Economic data were collected within the British Rheumatoid Outcome Study Group r and omised controlled trial of SCSC and ATH .  A broad perspective was used ( UK National Health Service , social support services and patients ) . Cost per quality adjusted life year ( QALY ) gained , net benefit statistics and cost effectiveness acceptability curves were estimated . Costs and outcomes were discounted at 3.5 % . Sensitivity analysis tested the robustness of the results to analytical assumptions . Results : The mean ( SD ) cost per person was £ 4540 ( 4700 ) in the SCSC group and £ 4440 ( 4900 ) in the ATH group . The mean ( SD ) QALYs per person for 3 years were 1.67 ( 0.56 ) in the SCSC group and 1.60 ( 0.60 ) in the ATH group . If decision makers are prepared to pay ⩾£2000 to gain 1 QALY , SCSC is likely to be cost effective in 60–90 % of cases . Conclusions : The primary economic analysis and sensitivity analyses indicate that SCSC is likely to be more cost effective than ATH in 60–90 % of cases . This result seems to be robust to assumptions required by the analysis . This study is one of a limited number of r and omised controlled trials to collect detailed re source use and health status data and estimate the costs and QALYs of treatment for established RA . This trial is one of the largest RA studies to use the EuroQol Background To estimate the proportion of diabetic patients ( DPts ) with peripheral vascular disease treated at a primary health care site after an endocrinologist-based intervention  , who meet ATP III and Steno targets of metabolic control , as well as to compare the outcome with the results of the patients treated by endocrinologists . Methods A controlled , prospect i ve over 30-months period study was conducted in area 7 of Madrid . One hundred twenty six eligible diabetic patients diagnosed as having peripheral vascular disease between January 2003 and June 2004 were included in the study . After a treatment period of three months by the Diabetes team at St Carlos Hospital , 63 patients were r and omly assigned to continue their follow up by diabetes team ( Group A ) and other 63 to be treated by the family physicians ( FP ) at primary care level with continuous diabetes team coordination ( Group B ) . 57 DPts from Group A and 59 from Group B , completed the 30 months follow-up period . At baseline both groups were similar in age , weight , time from diagnosis and metabolic control . The main outcomes of this study were the proportion of patients meeting ATP III and Steno goals for HbA1c ( % ) , Cholesterol , HDL cholesterol , LDL cholesterol , triglycerides , blood pressure , albumine-to-creatinine excretion ratio ( ACR ) , body mass index ( BMI ) , waist circumference ( WC ) , anti-aggregation treatment and smoking status . Results At the end of the follow up , no differences were found between the groups . More than 37 % of diabetic patients assigned to be treated by FP achieved a HbA1c < 6.5 % , more than 50 % a ACR < 30 mg/g , and more than 80 % reached low risk values for cholesterol , LDL cholesterol , triglycerides , diastolic blood pressure and were anti-aggregated , and 12 % remained smokers . In contrast , less than 45 % achieved a systolic blood pressure < 130 mm Hg , less than 12 % had a BMI < 25 Kg.m-2 ( versus 23 % in group A ; p < 0.05 ) and 49%/30 % ( men/women ) had a waist circumference of low risk . Conclusion Improvements in metabolic control among diabetic patients with peripheral vascular disease treated at a primary health care setting is possible , reaching similar results to the patients treated at a specialized level . Despite such an improvement , body weight control remains more than poor in both levels , mainly at primary care level . General practitioner and endocrinologist coordination care may be important to enhance diabetes management in primary care setting s . Trial registration Clinical Trial number IS RCT Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event Background Evidence -based practice s design ed for large urban clinics are not necessarily portable into smaller isolated clinics . Implementing practice -based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists . Objective The purpose of the Telemedicine Enhanced Antidepressant Management ( TEAM ) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists . Design Matched sites were r and omized to the intervention or usual care . Participants Small VA Community-based outpatient clinics with no on-site psychiatrists , but access to telepsychiatrists .  In 2003–2004 , 395 primary care patients with PHQ9 depression severity scores ≥12 were enrolled , and followed for 12 months . Patients with serious mental illness and current substance dependence were excluded .  Measures Medication adherence , treatment response , remission , health status , health-related quality of life , and treatment satisfaction . Results The sample comprised mostly elderly , white , males with substantial physical and behavioral health comorbidity . At baseline , subjects had moderate depression severity (  Hopkins Symptom Checklist , SCL-20 = 1.8 ) , 3.7 prior depression episodes , and 67 % had received prior depression treatment . Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 ( odds ratio [ OR ] = 2.1 , p = .04 ) and 12 months ( OR = 2.7 , p = .01 ) . Intervention patients were more likely to respond by 6 months ( OR = 2.0 , p = .02 ) , and remit by 12 months ( OR = 2.4 , p = .02 ) . Intervention patients reported larger gains in mental health status and health-related quality of life , and reported higher satisfaction . Conclusions Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies To test the feasibility and efficacy 
    Output:
    
This review suggests that shared care improves depression outcomes and probably has mixed or limited effects on other outcomes .
Review findings support the growing evidence base for shared care in the management of depression , particularly stepped care models of shared care .