***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 Heart failure ( HF ) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality . With an aging population , the cost associated with managing HF is expected to more than double from US $ 31 billion in 2012 to US $ 70 billion by 2030 . Readmission rates for HF patients are high—25 % are readmitted at 30 days and nearly 50 % at 6 months . Low medication adherence contributes to poor HF management and higher readmission rates .  Remote telehealth monitoring programs aim ed at improved medication management and adherence may improve HF management and reduce readmissions . Objective The primary goal of this r and omized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program .  We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department ( ED ) visits , increased medication adherence , and improved health-related quality of life ( HRQoL ) compared to usual care . Methods Participants were r and omized to usual care or use of the remote medication monitoring system for 90 days . Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants . Participants completed question naires at enrollment and closeout to gather data on medication adherence , health status , and HRQoL. Electronic medical records were review ed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period . Results Use of the medication monitoring system was associated with an 80 % reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care . Objective device data indicated high adherence rates ( 95%-99 % ) among intervention group participants despite finding no significant difference in self-reported adherence between study arms . The intervention group had poorer heart function and HRQoL at baseline , and HRQoL declined significantly in the intervention group compared to controls . Conclusions The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation . The MedSentry medication monitoring system may be useful both as a st and alone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions . We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls . Although HRQoL deteriorated significantly in the intervention group , this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls . Telehealth medication adherence technologies , such as the MedSentry medication monitoring system , are a promising method to improve patient self-management , the quality of patient care , and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens . Trial Registration Clinical Trials.gov NCT01814696 ; https:// clinical trials.gov/ct2/show/ study /NCT01814696 ( Archived by WebCite ® at http://www.webcitation.org/6giqAVhno Background : In recent years , leading organizations in inflammatory bowel disease ( IBD ) have developed quality measures for the care of adults with Crohn 's disease or ulcerative colitis . We used chart audits to assess the impact of quality improvement educational activities on documented adherence to Physician Quality Reporting System measures for IBD . Methods : Twenty community-based gastroenterologists were recruited to participate in baseline chart audits ( n = 200 ) , a series of 4 accredited educational activities with feedback , and follow-up chart audits ( n = 200 ) . Trained abstract ors review ed r and omly selected charts of adults with moderate or severe Crohn 's disease . The charts were retrospectively abstract ed for physicians ' documented performance of the 2013 Physician Quality Reporting System IBD quality measures . We compared the physicians ' baseline and posteducation rates of documented adherence with 10 of these measures . In a secondary analysis , we compared preeducation with posteducation difference scores of low-performing physicians , those whose baseline documentation rates were in the lowest quartile , and the rest of the cohort . Results : At baseline , documentation of mean provider-level adherence to the 10 quality measures ranged from 3 % to 98 % ( gr and mean = 35.8 % ) . In the overall analysis , baseline and posteducation rates of documented adherence did not differ significantly for any of the measures . However , for 4 measures , preeducation to posteducation difference scores were significantly greater among low performers than physicians in the highest 3 quartiles . Conclusions : The results of this preliminary pragmatic study indicate that quality improvement education affords the potential to improve adherence to Physician Quality Reporting System quality measures for IBD among low-performing gastroenterologists IMPORTANCE It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure ( HF ) after hospitalization . OBJECTIVE To evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF . DESIGN , SETTING , AND PARTICIPANTS We r and omized 1437 patients hospitalized for HF between October 12 , 2011 , and September 30 , 2013 , to the intervention arm ( 715 patients ) or to the usual care arm ( 722 patients ) of the Better Effectiveness After Transition-Heart Failure ( BEAT-HF ) study and observed them for 180 days . The date s of our study analysis were March 30 , 2014 , to October 1 , 2015 . The setting was 6 academic medical centers in California . Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF . INTERVENTIONS The intervention combined health coaching telephone calls and telemonitoring . Telemonitoring used electronic equipment that collected daily information about blood pressure , heart rate , symptoms , and weight . Central ized registered nurses conducted telemonitoring review s , protocol ized actions , and telephone calls . MAIN OUTCOMES AND MEASURES The primary outcome was readmission for any cause within 180 days after discharge . Secondary outcomes were all-cause readmission within 30 days , all-cause mortality at 30 and 180 days , and quality of life at 30 and 180 days . RESULTS Among 1437 participants , the median age was 73 years . Overall , 46.2 % ( 664 of 1437 ) were female , and 22.0 % ( 316 of 1437 ) were African American . The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge , which occurred in 50.8 % ( 363 of 715 ) and 49.2 % ( 355 of 722 ) of patients , respectively ( adjusted hazard ratio , 1.03 ; 95 % CI , 0.88 - 1.20 ; P = .74 ) . In secondary analyses , there were no significant differences in 30-day readmission or 180-day mortality , but there was a significant difference in 180-day quality of life between the intervention and usual care groups . No adverse events were reported . CONCLUSIONS AND RELEVANCE Among patients hospitalized for HF , combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01360203 Objective To test a multidisciplinary approach to reduce heart failure ( HF ) readmissions that tailors the intensity of care transition intervention to the risk of the patient using a suite of electronic medical record (EMR)-enabled programmes . Methods A prospect i ve controlled before and after study of adult in patients admitted with HF and two concurrent control conditions ( acute myocardial infa rct ion ( AMI ) and pneumonia ( PNA ) ) was performed between 1 December 2008 and 1 December 2010 at a large urban public teaching hospital . An EMR-based software platform stratified all patients admitted with HF on a daily basis by their 30-day readmission risk using a published electronic predictive model . Patients at highest risk received an intensive set of evidence -based interventions design ed to reduce readmission using existing re sources . The main outcome measure was readmission for any cause and to any hospital within 30 days of discharge . Results There were 834 HF admissions in the pre-intervention period and 913 in the post-intervention period . The unadjusted readmission rate declined from 26.2 % in the pre-intervention period to 21.2 % in the post-intervention period ( p=0.01 ) , a decline that persisted in adjusted analyses ( adjusted OR (AOR)=0.73 ; 95 % CI 0.58 to 0.93 , p=0.01 ) . In contrast , there was no significant change in the unadjusted and adjusted readmission rates for PNA and AMI over the same period . There were 45 fewer readmissions with 913 patients enrolled and 228 patients receiving intervention , result ing in a number needed to treat ( NNT ) ratio of 20 . Conclusions An EMR-enabled strategy that targeted scarce care transition re sources to high-risk HF patients significantly reduced the risk-adjusted odds of readmission Background High- quality bowel preparation is necessary for colonoscopy . A few studies have been conducted to investigate improvement in bowel preparation quality through patient education . However , the effect of patient education on bowel preparation has not been well studied . Methods A r and omized and prospect i ve study was conducted . All patients received regular instruction for bowel preparation during a pre-colonoscopy visit . Those scheduled for colonoscopy were r and omly assigned to view an educational video instruction ( video group ) on the day before the colonoscopy , or to a non-video ( control ) group .  Qualities of bowel preparation using the Ottawa Bowel Preparation Quality scale ( Ottawa score ) were compared between the video and non-video groups . In addition , factors associated with poor bowel preparation were investigated . Result A total of 502 patients were r and omized , 250 to the video group and 252 to the non-video group . The video group exhibited better bowel preparation ( mean Ottawa total score : 3.03 ± 1.9 ) than the non-video group ( 4.21 ± 1.9 ; P < 0.001 ) and had good bowel preparation for colonoscopy ( total Ottawa score < 6 : 91.6 % vs. 78.5 % ; P < 0.001 ) . Multivariate analysis revealed that males ( odds ratio [ OR ] = 1.95 , P = 0.029 ) , diabetes mellitus patients ( OR = 2.79 , P = 0.021 ) , and non-use of visual aids ( OR = 3.09 , P < 0.001 ) were associated with poor bowel preparation . In the comparison of the colonoscopic outcomes between groups , the polyp detection rate was not significantly different between video group and non-video group ( 48/250 , 19.2 % vs. 48/252 , 19.0 % ; P = 0.963 ) , but insertion time was significantly short in video group ( 5.5 ± 3.2 min ) than non-video group ( 6.1 ± 3.7 min ; P = 0.043 ) . Conclusion The addition of an educational video could improve the quality of bowel preparation in comparison with st and ard preparation method .Trial registration Clinical Research Information Service KCT0001836 . The date of registration : March , 08th , 2016 , Retrospectively registered BACKGROUND St and ards for the detection of adenomas during screening colonoscopy are widely used to measure examination quality . No such st and ards exist for sessile serrated adenomas ( SSAs ) . OBJECTIVE To measure both the adenoma detection rate ( ADR ) and SSA detection rate ( SSADR ) during screening colonoscopy before and after quality improvement/financial incentive measures . DESIGN Retrospective determination of baseline ADR/SSADR by the endoscopist , followed by prospect i ve collection of data after informing physicians of baseline detection rates . SETTING Tertiary cancer center with a large cancer screening program . PATIENTS A total of 2833 average-risk colorectal cancer screening patients 50 to 75 years of age undergoing initial colonoscopy . DATA COLLECTION Electronic medical records for indication and demographics , endoscopy report , and pathology report . MAIN OUTCOME MEASUREMENTS Detection rates of adenomas and SSAs by sex . RESULTS The overall ADR in male and female patients was 50.6 % and 36.6 % , respectively . The overall detection rate of advanced adenomas in male and female patients was 12.4 % and 6.5 % , respectively . The overall SSADR in male and female patients was 10.1 % and 7.1 % , respectively . In 108 patients ( 3.8 % of entire group ) , SSAs were the only premalignant lesions found . Detection rates of both types of premalignant polyps improved over time but did not reach statistical significance . LIMITATIONS Single-center experience with limited sample size and small group of endoscopists . CONCLUSION ADRs far in excess of current st and ards are achievable . Cecal withdrawal time is associated with the ADR . Prevalence of SSA rivals that of advanced adenomas and is greater than current medical literature suggests . The combination of monitoring and financial incentives did not result in statistically significant improvement in A 
    Output:
    
Education was the most common intervention , although most successful studies combined education with another intervention .
Many studies showed improved compliance to metrics , but few were able to show differences in length of stay , readmissions , or mortality .
Conclusions Our review of quality improvement literature in gastroenterology revealed common themes of successful programs : Education was frequently used but often insufficient , the EMR may be underutilized in guiding decision making , and patient-reported outcomes were infrequently assessed .