***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background : The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze . Methods : A prospect i ve , r and omised , partially blinded , controlled trial was design ed at two secondary care centres . Over a 13 month period 200 children aged 18 months to 5 years at the time of admission to a children 's ward or attendance at an accident and emergency department or children 's ( emergency ) assessment unit ( A&E/CAU ) with a primary diagnosis of acute severe asthma or wheezing were recruited . 101 children were r and omised into the control group and received usual care and 99 were assigned to the intervention group and received : ( 1 ) a pre-school asthma booklet ; ( 2 ) a written guided self-management plan ; and ( 3 ) two 20 minute structured educational sessions between a specialist respiratory nurse and the parent(s ) and child . Subjects were assessed at 3 , 6 , and 12 months . The main outcomes were GP consultation rates , hospital re-admissions , and attendances at A&E/CAU . Secondary outcomes included disability score , caregivers ' quality of life , and parental knowledge of asthma . Results : There were no statistically significant differences between the two groups during the 12 month follow up period for any of the main or secondary outcome measures . Conclusions : These results do not support the hypothesis that the introduction of an educational package and a written guided self-management plan to the parents of pre-school children with asthma who had recently attended hospital for troublesome asthma or wheeze reduces morbidity over the subsequent 12 months Context Research on patient safety has focused on adverse events in hospitalized patients .  Adverse events following hospitalization have received little attention . Contribution Among 400 consecutive patients discharged from the general medical service of an academic hospital , 76 had adverse events during the 2 weeks following hospital discharge . Of the adverse events , the research ers categorized 23 as preventable , 24 as ameliorable , and the remainder as neither . Adverse drug events were the most frequent occurrence . Implication s Interventions to maximize patient safety should consider the vulnerable transition from hospital to home . The Editors Patient safety is a public concern that has received substantial attention , especially since the release of two reports from the U.S. Institute of Medicine . The first of these , To Err Is Human , review ed the literature on adverse events , or injuries result ing from medical care ( 1 ) . On the basis of data from two large population -based chart review studies , the report estimated that adverse events occur in 2.9 % ( 2 ) to 3.7 % ( 3 ) of hospitalizations . The first of these studies ( 2 ) found that although most injuries are minor , approximately 1 in 10 results in death . The research ers determined that approximately half of the adverse events were caused by errors ( 1 , 3 , 4 ) . The second report , Crossing the Quality Chasm , which proposes strategies for improving the health system , declared patient safety a fundamental component of care quality ( 5 ) . However , the estimated incidence of adverse events quoted in To Err Is Human may underestimate the overall safety problem , since injuries occurring after discharge were not included in the evaluation . Patients may be especially vulnerable to injuries during this period because they may still have functional impairments and because discontinuities may occur at the interface of acute and ambulatory care ( 6 ) . These discontinuities may be worsened by the current health care environment , in which patients are leaving the hospital quicker and sicker ( 7 ) and may receive care from hospitalists rather than their primary care physicians ( 8) . Despite these theoretical concerns , few studies are available to estimate the extent of the problem . Several studies have determined the risk for postdischarge wound infections in surgical patients ( 9 , 10 ) , but this is a specific type of safety problem and the risk can not be generalized . Other studies have used readmission rates to identify poor- quality hospital care ( 11 ) . However , this outcome is an insensitive and nonspecific marker of quality in general ( 11 ) and safety in particular . Information on the incidence and type of adverse events is vital for improving postdischarge safety . We wanted to determine the incidence and severity of adverse events affecting patients after discharge from the hospital to home . In addition , we wanted to identify the incidence of preventable and ameliorable adverse events , classify types of adverse events , and identify system improvements to reduce the incidence and severity of adverse events after discharge . Methods Overview To determine the rate of adverse events , we first created a case summary of every patient 's posthospital course by performing a medical record review and a telephone interview approximately 3 weeks after discharge . Using this information , we created event summaries , which two board-certified internists independently review ed to determine whether medical management caused an injury and , if so , whether it was preventable or ameliorable . The institutional review board at the study hospital approved the protocol . Definitions Adverse outcomes were any of the following patient experiences after discharge : new or worsening symptoms , unanticipated visits to health facilities for tests or treatments , or death . An adverse event was an injury result ing from medical management rather than the underlying disease . We evaluated all injuries result ing in symptoms after discharge , regardless of when the events occurred . Thus , we included adverse events that occurred in the hospital and after discharge as long as symptoms persisted until the patient went home . A preventable adverse event was an injury that could have been avoided , that is , an injury judged to probably be the result of an error or a system design flaw . An ameliorable adverse event was an injury whose severity could have been substantially reduced if different actions or procedures had been performed or followed . Patient Sample We used a prospect i ve cohort design to study adult medical patients at an 800-bed urban academic teaching hospital . Patients were included if they went home from the general medical service during a sequential 81-day period , had telephone service , and could complete a telephone interview in English . Patient surrogates were permitted to complete the interview if the patient could not . Telephone Interview A board-certified internist contacted patients by telephone within 2 to 5 weeks of discharge . If the patient was eligible and consented , he or she underwent a semi-structured interview over the telephone . If the patient was not available , we made up to 20 attempts to contact him or her at different times of the day and week . If the patient declined to participate or we were unable to contact him or her after 5 weeks , we rated the patient as a nonresponder . Responders underwent a telephone interview that had several components ( Appendix Figure ) . The principal component assessed the patient 's condition since discharge by using a full review of organ systems . If patients answered yes to any question , the interviewer asked them to elaborate about the symptom 's severity , timing in relation to hospitalization and treatments , and resolution . The survey also determined patients ' use of health services since discharge , including home care services , physician services , visits to laboratories , and readmissions to the hospital . Preparation of Case Summaries To create a case summary , the internist combined the information from the telephone interview with information obtained from a review of the patient 's electronic medical record . This computerized clinical record contains h and over notes from the hospitalization ; discharge summaries ; previous orders and written instructions ; emergency department and clinic notes ; operative and procedure notes ; and all laboratory results , including results of radiography , electrocardiography , and pathologic examination . If necessary , the paper chart was also review ed to clarify information that was in the discharge summary or h and over notes . If patients returned to the study hospital after discharge , we were able to vali date their history by review ing their records . However , for patients receiving care elsewhere , we had to rely on firsth and accounts . Preparation of Event Summaries The internist review ed every patient 's case summary for adverse outcomes . If any were found , an event summary that consisted of a detailed description of each outcome , including its onset , its severity , the health services used during its treatment , and its resolution , was created for each one . If there were no adverse outcomes , then the event summary consisted of the case summary . Determination of Adverse Events Two other board-certified internists independently rated each event summary by using st and ard techniques as described elsewhere ( 3 ) . Each event summary was evaluated separately . Review ers first rated on a scale of 1 to 6 their confidence that medical management caused an injury . If their rating was 5 or 6 , indicating that the injury was probably or definitely caused by management , the event was considered an adverse event . For adverse events , the internists used implicit criteria to determine their preventability and ameliorability . The two review ers ' assessment s were then compared for causality , preventability , and ameliorability . If there was disagreement , the two review ers discussed the case to attempt to come to consensus . If they did not agree , a third board-certified internist rated the event independently . Next , review ers rated injury severity , health services used , type of injury , and location . Injury severity was categorized as serious laboratory abnormality only , one day of symptoms , several days of symptoms , nonpermanent disability , permanent disability , or death . Differentiation between several days of symptoms and nonpermanent disability relied on evidence that symptoms interfered with patients ' activities of daily living . We categorized health services used as none , additional visit to a physician , additional visit for laboratory testing in addition to a physician visit , visit to an emergency department , readmission to the hospital , or death . We were able to determine whether health services were additional because during the interview we asked whether the health service was arranged before discharge or specifically for the particular symptom . We used a st and ard approach to classify the type of injury ( 2 , 3 ) , categorizing each as an adverse drug event , a procedure-related injury , a nosocomial infection , a fall , or other . We also classified the location of adverse events . Our primary objective was to evaluate adverse events affecting patients after discharge from the hospital to home . We felt that most of these events would occur after the patient went home , but we recognized a priori that some adverse events could occur in the hospital but lead to morbidity after discharge because of the severity of the injury or because health providers did not recognize the problem at discharge . Examples of injuries occurring in the hospital but affecting patients after discharge include pressure ulcers , missed diagnoses , and erroneous drug prescriptions . If it was determined that the adverse event occurred in the hospital , we examined whether the injury was recognized before discharge and , if so , whether definitive management was instituted at that time . To develop strategies CONTEXT Inner-city high-risk infants often receive limited and fragmented care , a problem that may increase serious illness . OBJECTIVE To assess whether access to comprehensive care in a follow-up clinic is cost-effective in reducing life-threatening illnesses among high-risk , inner-city infants . DESIGN R and omized controlled trial . SETTING AND PARTICIPANTS A total of 887 very-low-birth-weight infants born in a Texas county hospital between January 1988 and March 1996 and followed up in a children 's hospital clinic . One hundred four infants who became ineligible or died after r and omization but before nursery discharge were excluded from the analysis . INTERVENTIONS Infants were r and omly assigned to receive routine follow-up care ( well-baby care and care for chronic illnesses ; n = 441 ) or comprehensive care ( which included the components of routine care plus care for acute illnesses , with 24-hour access to a primary caregiver ; n = 446 ) . MAIN OUTCOME MEASURES Life-threatening illnesses ( ie , causing death or hospital admission for pediatric intensive care ) occurring between nursery discharge and age 1 year , assessed by blinded evaluators from inpatient charts and state Medicaid and vital statistics records ; and hospital costs ( estimated from department-specific cost-to-charge ratios ) . RESULTS Comprehensive care result ed in a mean of 3.1 more clinic visits and 6.7 more telephone conversations with clinic staff ( P<.001 for both ) . One-year outcomes were unknown for fewer comprehensive-care infants than routine-care infants ( 9 vs 28 ; P = .001 ) . Identified deaths were similar ( 11 in comprehensive care vs 13 in routine care ; P = .68 ) . The comprehensive-care group had 48 % fewer life-threatening illnesses ( 33 vs 63 ; P<.001 ) , 57 % fewer intensive care admissions ( 23 vs 53 ; P = .003 ) , and 42 % fewer intensive care days ( 254 vs 440 ; P = .003 ) . Comprehensive care did not increase the mean estimated cost per infant for all care ( $ 6265 with comprehensive care and $ 9913 with routine care ) . CONCLUSION Comprehensive follow-up care by experienced caregivers can be highly effective in reducing life-threatening illness without increasing costs among high-risk inner-city infants . JAMA . 2000;284:2070 - 2076 A r and omised controlled study of an educational programme for children with asthma and their families was carried out by community child health nurses . Three hundred and sixty eight children aged 2 to 14 years were enrolled in the study after admission to hospital for asthma . The intervention group was visited monthly by a nurse for six months . The subjects were assessed six months later by a postal , self administered question naire . European children in the intervention group were taking significantly more drugs for the treatment of asthma six months after the index admission to hospital than those in the control group ( mean ( SD ) intake 2.7 ( 1.1 ) v 2.1 ( 1.0 ) , respectively ) . In particular , they were using more  theophylline  ( 56.6 % v 37.0 % ) and  inhaled steroids  ( 34.9 % v 21.0 % ) . There was no difference between the groups for parental reports of improvement , of missed schooling , and in severe attacks of asthma of not responding to the usual treatment at home . European children in the 
    Output:
    
Interventions that demonstrated reductions in subsequent utilization targeted children with specific chronic conditions , providing enhanced inpatient feedback and education reinforced with postdischarge support .