***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 OBJECTIVES This study describes the outcomes of an intervention program in Nursing Homes and their effects on emergency room attendance , hospital admissions , and pharmaceutical expenditure . MATERIAL AND METHODS This involved non-r and omised community intervention in Nursing Homes with a control group . The program was implemented gradually from 2007 to 2009 in 10 Nursing Homes ( 857 beds ) which participated voluntarily . The control group consisted of 14 Nursing homes ( 1,200 beds ) , which refused to participate or were not assigned to our Primary Care centres . Intervention consisted of comprehensive geriatric assessment and follow-up visits by trained personnel , review and adjustment of drug treatment , case management and staff training . RESULTS In the Nursing Homes where the program was carried out , emergency room attendance decreased from 1165‰ ( 95%CI 1100 - 1240 ] ) in 2006 to 674‰ ( 95%CI 620 - 730 ) in 2009 , while in the control group it increased from 1071 ( 95%CI 1020 - 1130 ) to 1246‰ ( 95%CI 1190 - 1310 ) . The hospital admissions also decreased from 48.4 % ( 95%CI 45 - 52 ) in 2006 to 32.1 % ( 95%CI 29 - 35 ) in 2009 , while in the control group increased from 43.5 % ( 95%CI 41 - 46 ) to 55.8 % ( 95%CI 53 - 59 ) . There was also a 9 % reduction in pharmacy cost compared with an increase of 11.9 % in the control group . CONCLUSIONS The intervention has proved effective at reducing hospital admissions and emergency room attendance in institutionalised patients , thereby streamlining pharmacy costs OBJECTIVES To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home ( NH ) residents . DESIGN Medical records were review ed as a component of a project design ed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization . SETTING NHs in Georgia . PARTICIPANTS In 10 NHs with high and 10 with low hospitalization rates , 10 hospitalizations were r and omly selected , including long- and short-stay residents . MEASUREMENTS Ratings using a structured review by expert NH clinicians . RESULTS Of the 200 hospitalizations , 134 ( 67.0 % ) were rated as potentially avoidable . Panel members cited lack of on-site availability of primary care clinicians , inability to obtain timely laboratory tests and intravenous fluids , problems with quality of care in assessing acute changes , and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations . CONCLUSION In this sample of NH residents , experienced long-term care clinicians commonly rated hospitalizations as potentially avoidable . Support for NH infrastructure , clinical practice and communication tools for health professionals , increased attention to reducing the frequency of medically futile care , and financial and other incentives for NHs and their affiliated hospitals are needed to improve care , reduce avoidable hospitalizations , and avoid unnecessary healthcare expenditures in this population 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 ) = 0.61 - 0.86 , P < .001 ) . Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group ( 13 % increase ) than the comparison group ( 69 % increase ) ( RR = 0.67 , 95 % CI = 0.56 - 0.82 , P < .001 ) . Conversely , there was no significant difference in the RR for surgical admissions between the intervention and comparison groups ( RR = 1.0 , 95 % CI = 0.68 - 1.46 , P = .99 ) . The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment ( STOPP/START ) medication intervention on clinical and economic outcomes . DESIGN Parallel-group r and omized trial . SETTING Chronic care geriatric facility . PARTICIPANTS Residents aged 65 and older prescribed with at least one medication ( N = 359 ) were r and omized to receive usual pharmaceutical care or undergo medication intervention . INTERVENTION Screening medications with STOPP/START criteria followed up with recommendations to the chief physician . MEASUREMENTS The outcome measures assessed at the initiation of the intervention and 1 year later were number of hospitalizations and falls , Functional Independence Measure ( FIM ) , quality of life ( measured using the Medical Outcomes Study 12-item Short-Form Health Survey ) , and costs of medications . RESULTS The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1 year ( P < .001 ) . The average drug costs in the intervention group decreased by 103 shekels ( US$ 29 ) per participant per month ( P < .001 ) . The average number of falls in the intervention group dropped significantly ( P = .006 ) . Rates of hospitalization , FIM scores , and quality of life measurements were similar for both groups . CONCLUSION Implementation of STOPP/START criteria reduced the number of medications , falls , and costs in a geriatric facility . Their incorporation in those and similar setting s is recommended OBJECTIVE To describe the process and outcomes of nursing home ( NH ) residents transferred to hospital EDs . METHODS This was a prospect i ve , observational study conducted at 2 Midwestern community teaching hospitals during a 12-month period . All elder patients ( > 64 years of age ) transferred to hospital EDs from regional NHs were eligible for the study . Hospital records were used to abstract relevant descriptive and clinical data . Need for ambulance use was grade d prospect ively using 3 categories of urgency developed in other studies . Transfers were considered " appropriate " based on outcome measures or if the problem necessitated diagnostic and /or therapeutic procedures not available in the NH . Transfer documentation was evaluated using a st and ardized 18-item checklist . RESULTS A total of 709 consecutive NH patients made 1,012 ED visits . Their mean age was 83.4 years ( range 65 - 100 ) ; 76 % were female . The majority of patients ( 94 % ) were transferred by ambulance . Ambulance transfer was classified as emergent ( 16 % of patients ) , urgent ( 45 % ) , or routine ( 39 % ) . There were 319 ( 45 % ) patients subsequently admitted to the hospital . Approximately 77 % ( 546/709 ) of the NH transfers were considered appropriate by the emergency physician ( EP ) . Sixty-seven patients ( 10 % ) were transferred without any documentation . For those patients with transfer documentation , 6 common discrepancies were identified . CONCLUSION Although the majority of NH transfers in this population were appropriate , many patients were transferred without adequate documentation for the EP The dem and s of long-term care facilities ( LTCFs ) residents are complex which usually require a range of professionals and caregivers to provide treatment and care . To reduce this fragmentation of care , integrated care models are developed in modern health care system , and a gradual change from traditional LTCF care to integrated care has occurred in many countries . Although integrated care is assumed to improve the quality of care , evidence s supporting these effects are insufficient . We recruited 7 private LTCF ( 74 residents ) in northern Taipei and r and omized them into integrated care model ( N=42 , mean age=82.8+/-8.0 years , 54.8 % males ) and traditional model ( N=32 , 81.7+/-8.8 years , 43.8 % males ) .  Integrated care model group was provided an actively working interdisciplinary team in addition to traditional nursing and personal care in traditional model group .  Physical function , nutritional status and several quality indicators ( unplanned feeding tube replacement , unplanned urinary catheter replacement , pneumonia , urinary tract infection and so on ) were compared with both groups . Overall , LTCF residents in the integrated care model group showed significant improvement in serum levels of albumin ( 3.78+/-0.32 vs. 3.60+/-0.45 , p=0.004 ) and hemoglobin ( 12.62+/-1.58 vs. 12.03+/-1.24 , p=0.004 ) during the study period . Among selected quality indicators , subjects in integrated care model group were similar to traditional model group except that integrated care model group had a significantly reduced unplanned feeding tube replacement rate . In conclusion , the clinical effectiveness of integrated care model among severly disabled LTCF residents is minimal and a further cost-effectiveness study is needed to promote optimal quality of care in this setting OBJECTIVE To assess effect of a complex , multidisciplinary intervention aim ed at reducing avoidable acute hospitalization of residents of residential aged care ( RAC ) facilities . DESIGN Cluster r and omized controlled trial . SETTING RAC facilities with higher than expected hospitalizations in Auckl and , New Zeal and , were recruited and r and omized to intervention or control . PARTICIPANTS A total of 1998 residents of 18 intervention facilities and 18 control facilities . INTERVENTION A facility-based complex intervention of 9 months ' duration . The intervention comprised gerontology nurse specialist (GNS)-led staff education , facility bench-marking , GNS resident review , and multidisciplinary ( geriatrician , primary -care physician , pharmacist , GNS , and facility nurse ) discussion of residents selected using st and ard criteria . MAIN OUTCOME MEASURES Primary end point was avoidable hospitalizations . Secondary end points were all acute admissions , mortality , and acute bed-days . Follow-up was for a total of 14 months . RESULTS The intervention did not affect main study end points : number of acute avoidable hospital admissions ( RR 1.07 ; 95 % CI 0.85 -  
    Output:
    
Despite the heterogeneity of studies , there is limited evidence that interventions delivered by geriatrics-trained staff  reduce hospitalisations in nursing home residents .