***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: PURPOSE the purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners ( NPs ) and physicians ( MDs ) in the primary care of adults with type 2 diabetes . METHODS Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and r and omized to an NP or MD practice .  Chart review s were conducted to assess processes of care ; patient interviews and hemoglobin Al C ( Al C ) testing were performed to measure patient outcomes . RESULTS NPs were more likely than MDs to document provision of general diabetes education and education about nutrition , weight , exercise , and medications . They were more likely to document patient height , urinalyses results , and Al C values . No differences were found in documenting current medications ; alcohol , illicit drug , or tobacco use ; depression ; weight and blood pressure ; foot and cardiovascular exams ; blood glucose and creatinine testing ; or referral to ophthalmologists . No differences were found in patient outcomes . CONCLUSIONS This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes . NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs ; however , these differences were not reflected in 6-month patient outcomes CONTEXT Most older adults with dementia will be cared for by primary care physicians , but the primary care practice environment presents important challenges to providing quality care . OBJECTIVE To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 153 older adults with Alzheimer disease and their caregivers who were r and omized by physician to receive collaborative care management ( n = 84 ) or augmented usual care ( n = 69 ) at primary care practice s within 2 US university-affiliated health care systems from January 2002 through August 2004 . Eligible patients ( identified via screening or medical record ) met diagnostic criteria for Alzheimer disease and had a self-identified caregiver . INTERVENTION Intervention patients received 1 year of care management by an interdisciplinary team led by an advanced practice nurse working with the patient 's family caregiver and integrated within primary care . The team used st and ard protocol s to initiate treatment and identify , monitor , and treat behavioral and psychological symptoms of dementia , stressing nonpharmacological management . MAIN OUTCOME MEASURES Neuropsychiatric Inventory ( NPI ) administered at baseline and at 6 , 12 , and 18 months . Secondary outcomes included the Cornell Scale for Depression in Dementia ( CSDD ) , cognition , activities of daily living , re source use , and caregiver 's depression severity . RESULTS Initiated by caregivers ' reports , 89 % of intervention patients triggered at least 1 protocol for behavioral and psychological symptoms of dementia with a mean of 4 per patient from a total of 8 possible protocol s. Intervention patients were more likely to receive  cholinesterase inhibitors  ( 79.8 % vs 55.1 % ; P = .002 ) and  antidepressants  ( 45.2 % vs 27.5 % ; P = .03 ) . Intervention patients had significantly fewer behavioral and psychological symptoms of dementia as measured by the total NPI score at 12 months ( mean difference , -5.6 ; P = .01 ) and at 18 months ( mean difference , -5.4 ; P = .01 ) . Intervention caregivers also reported significant improvements in distress as measured by the caregiver NPI at 12 months ; at 18 months , caregivers showed improvement in depression as measured by the Patient Health Question naire-9 . No group differences were found on the CSDD , cognition , activities of daily living , or on rates of hospitalization , nursing home placement , or death . CONCLUSIONS Collaborative care for the treatment of Alzheimer disease result ed in significant improvement in the quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers . These improvements were achieved without significantly increasing the use of antipsychotics or sedative-hypnotics . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00246896 CONTEXT Low-income seniors frequently have multiple chronic medical conditions for which they often fail to receive the recommended st and ard of care . OBJECTIVES To test the effectiveness of a geriatric care management model on improving the quality of care for low-income seniors in primary care . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 951 adults 65 years or older with an annual income less than 200 % of the federal poverty level , whose primary care physicians were r and omized from January 2002 through August 2004 to participate in the intervention ( 474 patients ) or usual care ( 477 patients ) in community-based health centers . INTERVENTION Patients received 2 years of home-based care management by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocol s for common geriatric conditions . MAIN OUTCOME MEASURES The Medical Outcomes 36-Item Short-Form ( SF-36 ) scales and summary measures ; instrumental and basic activities of daily living ( ADLs ) ; and emergency department ( ED ) visits not result ing in hospitalization and hospitalizations . RESULTS Intention-to-treat analysis revealed significant improvements for intervention patients compared with usual care at 24 months in 4 of 8 SF-36 scales : general health ( 0.2 vs -2.3 , P = .045 ) , vitality ( 2.6 vs -2.6 , P < .001 ) , social functioning ( 3.0 vs -2.3 , P = .008 ) , and mental health ( 3.6 vs -0.3 , P = .001 ) ; and in the Mental Component Summary ( 2.1 vs -0.3 , P < .001 ) . No group differences were found for ADLs or death . The cumulative 2-year ED visit rate per 1000 was lower in the intervention group ( 1445 [ n = 474 ] vs 1748 [ n = 477 ] , P = .03 ) but hospital admission rates per 1000 were not significantly different between groups ( 700 [ n = 474 ] vs 740 [ n = 477 ] , P = .66 ) . In a predefined group at high risk of hospitalization ( comprising 112 intervention and 114 usual-care patients ) , ED visit and hospital admission rates were lower for intervention patients in the second year ( 848 [ n = 106 ] vs 1314 [ n = 105 ] ; P = .03 and 396 [ n = 106 ] vs 705 [ n = 105 ] ; P = .03 , respectively ) . CONCLUSIONS Integrated and home-based geriatric care management result ed in improved quality of care and reduced acute care utilization among a high-risk group . Improvements in health-related quality of life were mixed and physical function outcomes did not differ between groups . Future studies are needed to determine whether more specific targeting will improve the program 's effectiveness and whether reductions in acute care utilization will offset program costs . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00182962 Purpose : The purpose of this research was to evaluate the impact of a nurse‐directed approach to patient education , which focused on lifestyle modification , daily weight management , diet , and medication compliance to improve the quality of life ( QOL ) and functional capacity in people with heart failure . Data sources : This was a prospect i ve quasiexperimental multicenter research study of 23 patients comparing a nurse‐directed care ( NC ) group ( n= 13 ) , which received comprehensive disease management education and weekly telephone follow‐up , and the routine care ( RC ) group ( n= 10 ) that received protocol ‐driven medical management .  The study length was 12 months . Conclusions : Analysis of covariance ( ANCOVA ) was used to test for e quality of variance – covariance matrices in the study population over time . ANCOVA measured baseline and two data intervals for a total of 9 months between the control and experimental ( NC and RC ) groups . There was statistically significant improvement in the NC group for the domains of total QOL : F= 3.569 , p= 0.000 ; health and function : F= 3.995 , p= 0.003 ; social and economic : F= 14.109 , p= 0.000 ; psychological and spiritual : F= 13.212 , p= 0.000 ; and family : F= 2.384 , p= 0.048 . Functional capacity was not significantly impacted by the study team interventions ( F= 0.228 , p= 0.949 ) . Implication s for practice : Results indicate that nurse‐directed patient education was effective in improving QOL .  A nurse‐directed treatment strategy significantly improves patients ’ role in symptom control and disease self‐management OBJECTIVES The objective of this study was to determine if outcomes of care for nursing home residents differ between two groups of providers : nurse practitioners/physicians and physicians only . DESIGN We conducted a retrospective chart review covering the 12-month period from September 1 , 1997 , until August 31 , 1998 . SETTING We studied eight nursing homes in central Texas . PARTICIPANTS Two hundred three residents were r and omly selected who resided in one of the eight nursing homes during the specified time period . STATISTICAL ANALYSIS We used chi-squared or Fisher exact test for comparisons of percent and Student t test for comparison of means ; comparisons were made with both the FREQ procedure and the univariate procedure . RESULTS Acute visits were significantly higher for the nurse practitioner/physician team ( 3.0 + /- 2.4 ) versus the physician-only group ( 1.2 + /- 1.5 ) . The nurse practitioner/physician group treated significantly more eye , ear , nose , and throat and dermatologic diagnoses than the physician-only group . Emergency department visits , emergency department costs , hospitalizations , length of stay , hospital costs , performance of m and ated progress visits , and performance of annual history and physicals did not show significant differences between the two groups . CONCLUSION The level of care provided for patients by the two groups of providers was basically the same and of similar quality ; however , the nurse practitioner/physician group patients were seen more often . Increased visits by nurse practitioners are assumed to result in time and cost savings for physicians and improved access to care for patients This experimental pilot project examined 33 acute care patients over age 70 to determine if length of stay , cost of stay , and functional decline during hospitalization  could be reduced through early assessment . A gerontological clinical nurse specialist ( GCNS ) , using three established instruments , scored all patients within 72 hours of admission to the study unit in relation to mental status , physical functioning , and ability to perform activities of daily living . The instruments included the ( a ) Mini-Mental State Exam ( MMSE ) , ( b ) PULSES Profile , and ( c ) Katz Index of Activities of Daily Living ( Katz ADL ) . The GCNS 's assessment s and recommendations for care were documented in patient charts . Subjects were r and omly assigned to experimental or control groups . Those in the experimental group received GCNS monitoring , which included daily ( except weekends ) patient visits to assess newly developed problems , response to interventions , and follow-through on previous recommendations . Other patients received only the usual care . Subjects were retested prior to discharge . The differences between change scores from admission to discharge were not statistically significant . However , the GCNS observed several positive trends in medical and nursing staff practice s in relation to increased staff awareness of geriatric care needs . Replication of this study using a larger sample of high-risk elderly patients is needed to further delineate the potential benefits of the unit-based model OBJECTIVE To compare midwifery and medical care practice s and measure optimal perinatal outcomes using a new clinimetric instrument . DESIGN Prospect i ve descriptive cohort design . SETTING A large , inner city obstetric service with medical and midwifery services . PARTICIPANTS Three hundred seventy-five of 400 consecutively enrolled patients were participated ( 25 excluded due to extreme risk status or missing data ) ; 92 % were of minority race/ethnicity and 54 % had less than a high school education . Of the 375 patients , 179 received physician care and 196 received nurse-midwife care . MAIN OUTCOME MEASURES The Optimality Index-US was measured . Health record data were extracted and scored using the Optimality Index-US to summarize the optimality of processes and outcomes of care as well as the woman 's preexisting health status . RESULTS Midwifery patients had more optimal care processes ( less use of technology and intervention ) with no difference in neonatal outcomes , even when preexisting risk was taken into account . CONCLUSION Even among moderate-risk patients , the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model Background —Black subjects with a family history of premature coronary heart disease ( CHD ) have a marked excess risk , yet barriers prevent effective risk reduction . We tested a community-based multiple risk factor intervention ( community-based care [ CBC ] ) and compared it with “ enhanced ” primary care ( EPC ) to reduce CHD risk in high-risk black families . Methods and Results —Black 30- to 59-year-old siblings of a prob and with CHD aged < 60 years were 
    Output:
    
This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the population s and in the setting s included .
Use of clinical nurse specialists in acute care setting s can reduce length of stay and cost of care for hospitalized patients .