***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: The purpose of this study was to evaluate  primary and team nursing on two 45-bed geriatric units . A 2 year longitudinal study with a quasi-experimental ABA cross-over design and a staff survey , permitted comparisons of the two nursing systems on indices of patient well-being , nursing practice , staff morale and costs . Differences in nursing practice , in selected measures of patient well-being and in responses to the staff survey were positively associated with primary nursing . No differences emerged in relation to staff morale or costs . The benefits of primary nursing and implication s for further research are discussed This study is part of a project that aim ed to increase the participation of informal caregivers in the hospital care for elderly patients . The staff who worked in the wards that were studied created activity programmes for caregivers and changed their ward policies to encourage the participation of the caregivers . In addition , quality assurance programmes were developed and primary nursing was introduced to ensure individualized , need-based and family centered care . In order to explore the changes in perceived quality of care , and to test the differences in care quality between the study and the control wards ( i.e. two wards in a university hospital , two wards in a geriatric unit and two wards of a nursing home ) , the interrupted time series with a non-equivalent control group time series design was used . During periods of 2 months in 1991 , 1992 and 1993 the data were collected from elderly patients ( n = 97 ) and their informal caregivers ( n = 369 ) using a structured question naire based on need theories . The results indicated that the quality of care was improved , especially in the study wards of the university hospital and of the nursing home . This care quality measure was found to be a useful tool for getting feedback from patients and their caregivers concerning care given . Aspects of nursing practice that needed to be improved were identified ( i.e. poor communication between the patient , their caregiver and staff , and lack of support to the patient and caregiver by staff ) In a resident-oriented care model applied in nursing homes , the residents are assigned to primary nurses . These primary nurses are responsible for the total care of the residents assigned to them . The purpose of the present study , using a pretest , post-test and control group quasi-experimental design , was to evaluate the effects of the implementation of resident-oriented care on the following aspects of quality of care : coordination of care , instrumental aspects , expressive aspects , resident wellbeing and satisfaction with care , and family satisfaction with care . The study was carried out on somatic and psycho-geriatric wards in three nursing homes in the Netherl and s. Data were collected by question naires , interviews and observations . The results of the study showed that the intervention was partly successful in the experimental group . Some aspects of the resident-oriented care model were not clearly evident . Moreover , the effects on quality -of-care aspects were limited . The results revealed that the ' coordination of care ' increased on half of the experimental wards . Furthermore , there was an indication that ' expressive aspects ' changed in favour of the experimental wards . The implementation of resident-oriented care had no effect on resident wellbeing and satisfaction or on family satisfaction . Finally , the results are discussed in the light of some method ological limitations that often go together with intervention studies in the real world OBJECTIVES To determine the effects of a small-house nursing home model , THE GREEN HOUSE ( GH ) , on residents ' reported outcomes and quality of care . DESIGN Two-year longitudinal quasi-experimental study comparing  GH residents with residents at two comparison sites using data collected at baseline and three follow-up intervals . SETTING Four 10-person GHs , the sponsoring nursing home for those GHs , and a traditional nursing home with the same owner . PARTICIPANTS All residents in the GHs ( 40 at any time ) at baseline and three 6-month follow-up intervals , and 40 r and omly selected residents in each of the two comparison groups . INTERVENTION The GH alters the physical scale environment ( small-scale , private rooms and bathrooms , residential kitchen , dining room , and hearth ) , the staffing model for professional and certified nursing assistants , and the philosophy of care . MEASUREMENTS Scales for 11 domains of resident quality of life , emotional well-being , satisfaction , self-reported health , and functional status were derived from interviews at four points in time . Quality of care was measured using indicators derived from Minimum Data Set assessment s. RESULTS Controlling for baseline characteristics ( age , sex , activities of daily living , date of admission , and proxy interview status ) , statistically significant differences in self-reported dimensions of quality of life favored the GHs over one or both comparison groups . The quality of care in the GHs at least equaled , and for change in functional status exceeded , the comparison nursing homes . CONCLUSION The GH is a promising model to improve quality of life for nursing home residents , with implication s for staff development and medical director roles CONTEXT Death is common in nursing homes , but access to palliative care is limited . OBJECTIVE To test whether a quality improvement ( QI ) intervention in nursing homes increases hospice , pain management , and advance care planning . DESIGN AND SETTING The QI intervention was tested in seven nursing homes using a prepost study design . Two additional nursing homes served as control sites . PARTICIPANTS Nine nursing homes serving 1169 residents . INTERVENTION The intervention included recruitment and training of Palliative Care Leadership Teams in each facility , followed by six technical assistance meetings for team members . Hospice providers delivered six educational sessions for all nursing home staff using a structured curriculum . Teams received feedback of performance data on hospice enrollment , pain management , and advance care planning at 0 , 3 , and 6 months . MAIN OUTCOME MEASURES Percentage of residents receiving hospice or palliative services , pain assessment , pain treatment among residents in pain , and documented advance care planning discussion s. RESULTS Intervention facilities increased hospice enrollment from 4.0 % of residents at baseline to 6.8 % postintervention ( p = .01 ) and increased pain assessment s from 18 % to 60 % ( p < .001 ) . Among resident in pain , orders for nonpharmacologic pain treatments increased from 15 % to 35 % ( p < .001 ) , but pain medication use did not change . Residents with in-depth discussion s about end-of-life care increased from 4 % to 17 % ( p < .001 ) . There were no significant changes in control sites . CONCLUSIONS A quality improvement intervention was effective in increasing hospice enrollment , pain assessment , nonpharmacologic pain treatment , and advance care planning discussion BACKGROUND In nursing homes there is a gradual move from traditional care to integrated care . Integrated care means a dem and -oriented , small-scale , co-operated and coordinated provision of services by different caregivers . This integration has direct effect on the work of these separate disciplines . With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved . OBJECTIVES The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers ( work content , communication and co-operation and worker 's outcomes ) . DESIGN A non-equivalent pre-test/post-test control group design was used in this study . SETTING S AND PARTICIPANTS Two nursing homes in the Netherl and s participated in the study . One nursing home provided the  five experimental nursing wards and the other nursing home provided four control wards .  METHOD Data were selected by means of written question naires . RESULTS The results showed that the intervention appeared to be only successful on the somatic wards . The caregivers of these wards were more able to create a home-like environment for their residents , to use a dem and -oriented working method and to integrate the provision of care and services . Regarding the effects of the intervention on quality of work factors , the results included an increase of social support by the supervisor , an increase of the degree of collaboration and a decrease in job dem and s. No changes were found for the worker 's outcomes such as job satisfaction . CONCLUSIONS The intervention on the psycho-somatic wards was unsuccessful . Although the introduction of integrated care on the somatic wards was successful , the effects on quality of work were limited . Next to quantitative research , more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations , with special attention for specific characteristics of different types of nursing home care ( somatic vs. psycho-geriatric ) Several studies have examined the effectiveness of geriatric assessment teams in outpatient and acute care setting s. This project compared medical records of 69 consecutive nursing home patients r and omly assigned on arrival to team ( n = 33 ) and nonteam ( st and ard care , n = 36 ) conditions .  Quality -of-care indices and healthcare service utilization were compared over a 12-month postadmission period . Team patients had a significantly greater number of diagnoses and ancillary services combined with nonsignificant trends toward decreased mortality , fewer emergency department visits , and fewer drugs prescribed . The team approach improves quality of care . Additional clinical studies evaluating the effectiveness of geriatric assessment teams should be made in other nursing homes OBJECTIVES To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants . DESIGN A multi-site r and omized clinical trial with matched groups , and measurements at baseline and after seven months . SETTING Sixteen psychogeriatric wards in fourteen nursing homes in the Netherl and s. PARTICIPANTS One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer ( DAT ) type , mixed DAT and vascular dementia , and dementia syndrome ( NAO ) and 99 nursing assistants . INTERVENTIONS Integrated emotion-oriented care and usual care . MESUREMENTS : Demented elderly : Behaviour and mood related to adaptation to the illness and the institutionalization . Nursing assistants : General health as measured by feelings of stress , stress reactions , feeling of competence and illness . RESULTS Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks : maintaining an emotional balance ( less anxiety ) and preserving a positive self-image ( less dissatisfaction ) . In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training . CONCLUSION Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia . For the severely demented elderly we did not find this surplus value . This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes . With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them OBJECTIVES --To assess the effect of preventive home visits by public health nurses on the state of health of and use of services by elderly people living at home . DESIGN --R and omised controlled trial . SETTING --General population of elderly people in one of the southern regions of the Netherl and s. SUBJECTS--580 subjects aged between 75 and 84 years r and omly allocated to intervention ( 292 ) or control ( 288 ) group . INTERVENTIONS --Four visits a year over three years in intervention group . Control group received no home visits . MAIN OUTCOME MEASURES --Self rated health , functional state , well being , loneliness , aspects of the mental state ( depressive complaints , memory disturbances ) , and mortality . Use of services and costs . RESULTS --Visits had no effect on the health of the subjects . In the group visited no higher scores were seen on health related measures , fewer died ( 42 ( 14 % ) v 50 ( 17 % ) ) , and community care increased slightly . In the control group more were referred to outpatient clinics ( 166 ( 66 % ) v 132 ( 55 % ) ) , and they had a 40 % increased risk of admission ( incidence rate ratio 1.4 ; 90 % confidence interval 1.2 to 1.6 ) . No differences were found in long term institutional care , and overall expenditure per person in the intervention group exceeded that in the control group by 4 % . Additional analyses showed that visits were effective for subjects who initially rated their health as poor . CONCLUSIONS --Preventive home visits are not beneficial for the general population of elderly people living at home but might be effective when restricted to subjects with poor health PURPOSE The purpose of this study was to describe the processes of care , organizational attributes , cost of care , staffing level , and staff mix in a sample of Missouri homes with good , average , and poor resident outcomes . DESIGN AND METHODS A three-group exploratory study design was used , with 92 nursing homes r and omly selected from all nursing homes in Missouri and classified into resident outcome groups . Resident outcomes were measured by use of quality indicators derived from nursing home Minimum Data Set resident assessment data . Cost and staffing information were derived from Medicaid cost reports . Participant observation methods were used to describe the care delivery processes . RESULTS In facilities with good resident outcomes , there are basics of care and processes surrounding each that staff consistently do : helping residents with ambulation , nutrition and hydration , and toileting and bowel regularity ; preventing skin breakdown ; and managing pain . The analysis revealed necessary organizational attributes that must be in place in order for those basics of care to be accomplished : consistent nursing and administrative leadership , the use of team and group processes , and an active quality improvement program . The only facility characteristic across the outcome groups that was significantly different was the number of licensed beds , with smaller facilities having better outcomes . No significant differences in costs , staffing , or staff mix were detected across the groups . A trend in higher total costs of 13.58 dollars per resident per day was detected in the poor- outcome group 
    Output:
    
The primary -care model was found to provide slightly better results than the comparator for some outcomes such as resident well-being or behaviour .
Therefore , these studies should be regarded with caution and there is little clear evidence for the effective use of any specific model of care in residential aged care to benefit either residents or care staff .