***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: Physicians commonly assume that they can educate hospitalized patients to follow prescribed treatment plans after discharge . In a prospect i ve , controlled study , we assessed the effectiveness of a  discharge interview  given to each of 545 hospitalized patients assigned to one of four groups : a group in which the physicians caring for the patients  received a 35-minute tutorial on how to conduct a discharge interview ( n = 181 ) , a group that received a 15-minute discharge interview from an investigator ( n = 53 ) , a group that received both interventions ( n = 63 ) , or a control group ( n = 248 ) . One month after discharge , all patients were telephoned , and a st and ardized question naire was administered . Results revealed that , 1 month after discharge , there were no significant differences among the four groups in knowledge of diagnosis , symptom status , activity level , medication knowledge and compliance , appointment keeping , and rates of rehospitalization . These results suggest that effective inpatient education may require more than a discharge interview OBJECTIVES To study the feasibility and effectiveness of a  discharge planning intervention . DESIGN Quasi-experimental pre-post study design . SETTING General medicine wards at three hospitals : an academic medical center , a community teaching hospital , and a community-based nonteaching hospital . PARTICIPANTS All patients aged 65 and older admitted to the hospitalist services . INTERVENTION The intervention toolkit had five core elements : admission form with geriatric cues , facsimile to the primary care provider , interdisciplinary worksheet to identify barriers to discharge , pharmacist-physician collaborative medication reconciliation , and predischarge planning appointments . MEASUREMENTS Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge . Odds ratios were determined , and site effects were examined accordig to interaction terms and Breslow Day statistics . RESULTS Two hundred thirty-seven patients were followed during the preintervention period , and 185 were exposed to the intervention . Patients characteristics were similar across the two time periods . The proportion of patients with high- quality transitions home , measured according to Coleman 's Care Transition Measures , increased from 68 % to 89 % ( odds ratio (OR)=3.49 , 95 % confidence interval (CI)=2.06 - 5.92 ) . Return to the emergency department within 3 days of discharge was lower in the intervention period ( 10 % vs 3 % , OR=0.25 , 95 % CI=0.10 - 0.62 ) . At 30 days , there was a lower rate of readmission ( 22 % vs 14 % , OR=0.59 , 95 % CI=0.34 - 0.97 ) and fewer visits to the emergency department ( 21 % vs 14 % , OR=0.61 , 95 % CI=0.36 - 1.03 ) ( P=.06 ) . CONCLUSION When hospitalized elderly patients are treated with consideration of their specific needs , healthcare outcomes can be improved AIMS To test the effect of education and support by a nurse on self-care and re source utilization in patients with heart failure . METHODS A total of 179 patients ( mean age 73 , 58 % male , NYHA III-IV ) hospitalized with heart failure were evaluated prospect ively . Patients were r and omized to the study intervention or to ' care as usual '  . The supportive educative intervention consisted of intensive , systematic and planned education by a study nurse about the consequences of heart failure in daily life , using a st and ard nursing care plan developed by the research ers for older patients with heart failure . Education and support took place during the hospital stay and at a home visit within a week of discharge . Data were collected on self-care abilities , self-care behaviour , readmissions , visits to the emergency heart centre and use of other health care re sources . RESULTS Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure . Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge , but the increase in the intervention group was significantly more after 1 month . Although self-care behaviour in both groups decreased during the following 8 months , the increase from baseline remained statistically significant in the intervention group , but not in the control group . No significant effects on re source utilization were found . CONCLUSIONS Intensive , systematic , tailored and planned education and support by a nurse results in an increase in patients ' self-care behaviour . No significant effects were found on use of health care re sources . Additional organisational changes , such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support The purpose of this study was to examine the effects of a  nurse- design ed discharge-planning project in a teaching hospital in Taiwan . A before- and -after quasi-experimental design was used .  Craniotomy ( n = 112 ) and stroke ( n = 171 ) patients were recruited and divided into control and intervention groups . Outcome indicators included length of hospital stay , change in activities of daily living ( ADL ) , rate of nursing home placement , rate of unplanned readmission , and level of satisfaction . In the stroke sample length of hospital stay was shorter in the intervention group than in the control group . In the craniotomy sample unplanned readmission was less frequent in the intervention group than in the control group . No differences were found between the control and intervention groups in other outcome indicators To select patients for early discharge planning , a r and omized clinical trial evaluated a protocol that used risk factors identified upon hospital admission . The goal of the study was to determine if intervention with high-risk patients could reduce the need for hospital admission or skilled care .  Of 13,255 patients screened , 835 study participants were identified as " at risk " for frequent health care re source use . Half of the high-risk patients were r and omly assigned to the experimental group ( n=417 ) and received discharge planning from day 3 of their hospital stay , while the control group ( n=418 ) received discharge planning only if there was a written physician request . Those patients receiving early , systematic discharge planning experienced an increased likelihood of successful return to home after hospital admission and a decreased chance of unscheduled readmission for the 9-month study period . Length of the index hospital stay was not affected by early planning , however . The major clinical implication is the potential for discharge planners to decrease the need for , and use of , health care re sources after hospital admission Inpatient discharge surveys at Middlemore hospital , a 600 bed hospital in South Auckl and , New Zeal and , consistently rate communication and co-ordination of care as parameters in need of improvement . A case management model of care was suggested as a means of achieving this . The objective of this study was to determine the effectiveness of care co-ordination in an acute general medical setting in a pilot study over a 4 week period . A care co-ordinator identified 18 patients with complex problems among 48 patients admitted to a single medical ward under the care of a single multidisciplinary team , with their care being co-ordinated over the entire episode of illness . A control group of 59 similarly complex patients admitted to other wards and teams without care co-ordination over the same period was also studied and the outcomes compared .  Communication and co-ordination , discharge information , involvement in discharge planning and information on post-discharge services were rated by the study patients as good or very good by 77 , 85 , 69 and 77 % , respectively , compared with 62 , 30 , 41 and 45 % in the control group . The same parameters were rated as poor or very poor by 13 , 30 , 36 and 15 % of the control patients , compared with 0 % in all these measures in the study group . Twenty-one clinical staff involved in the study agreed that there was an improvement in care co-ordination with respect to efficiency , reduction of workload and better communication , with approval ratings being 71 , 76 and 76 % , respectively . There was no difference in Average Length of Stay between the control and study groups , but three of the patients in the control group may have had their preventable readmissions within 10 days avoided if their care had been co-ordinated during their initial admission BACKGROUND Patients with complex care needs who require care across different health care setting s are vulnerable to experiencing serious quality problems . A care transitions intervention design ed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates . METHODS R and omized controlled trial . Between September 1 , 2002 , and August 31 , 2003 , patients were identified at the time of hospitalization and were r and omized to receive the intervention or usual care .  The setting was a large integrated delivery system located in Colorado . Subjects ( N = 750 ) included community-dwelling adults 65 years or older admitted to the study hospital with 1 of 11 selected conditions . Intervention patients received ( 1 ) tools to promote cross-site communication , ( 2 ) encouragement to take a more active role in their care and to assert their preferences , and ( 3 ) continuity across setting s and guidance from a " transition coach . "  Rates of rehospitalization were measured at 30 , 90 , and 180 days . RESULTS Intervention patients had lower rehospitalization rates at 30 days ( 8.3 vs 11.9 , P = .048 ) and at 90 days ( 16.7 vs 22.5 , P = .04 ) than control subjects . Intervention patients had lower rehospitalization rates for the same condition that precipitated the index hospitalization at 90 days ( 5.3 vs 9.8 , P = .04 ) and at 180 days ( 8.6 vs 13.9 , P = .046 ) than controls . The mean hospital costs were lower for intervention patients ( $ 2058 ) vs controls ( $ 2546 ) at 180 days ( log-transformed P = .049 ) . CONCLUSION Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rates of subsequent rehospitalization OBJECTIVE --To evaluate the effectiveness of the role of a discharge coordinator whose sole responsibility was to plan and coordinate the discharge of patients from medical wards . DESIGN --An intervention study in which the quality of discharge planning was assessed before and after the introduction of a discharge coordinator . Patients were interviewed on the ward before discharge and seven to 10 days after being discharged home . SETTING --The three medical wards at the Homerton Hospital in Hackney , East London . PATIENTS --600 r and omly sample d adult patients admitted to the medical wards of the study hospital , who were resident in the district ( but not in institutions ) , were under the care of physicians ( excluding psychiatry ) , and were discharged home from one of the medical wards . The sampling was conducted in three study phases , over 18 months . INTERVENTIONS --Phase I comprised base line data collection ; in phase II data were collected after the introduction of the district discharge planning policy and a discharge form ( checklist ) for all patients ; in phase III data were collected after the introduction of the discharge coordinator . MAIN MEASURES --The quality and out come of discharge planning . Readmission rates , duration of stay , appropriateness of days of care , patients ' health and satisfaction , problems after discharge , and receipt of services . RESULTS --The discharge coordinator result ed in an improved discharge planning process , and there was a reduction in problems experienced by patients after discharge , and in perceived need for medical and healthcare services . There was no evidence that the discharge coordinator result ed in a more timely or effective provision of community services after discharge , or that the appropriateness or efficiency of bed use was improved . CONCLUSIONS --The introduction of a discharge coordinator improved the quality of discharge planning , but at additional cost PURPOSE Several r and omized trials have found that discharge planning improves outcomes for hospitalized patients . We do not know if adding a clinical nurse specialist ( CNS ) to physician teams in hospitals that already have discharge planning services makes a difference . METHODS In 2 teaching hospitals , patients were r and omly assigned to regular hospital care or care with a clinical nurse specialist . The clinical nurse specialist facilitated hospital care by retrieving preadmission information , arranging in-hospital consultations and investigations , organizing postdischarge follow-up visits , and checking up on patients postdischarge with a telephone call . In-hospital outcomes included mortality and length of stay . Postdischarge outcomes included time to readmission or death , patient satisfaction , and the risk of adverse event . Adverse events were poor outcomes due to medical care rather than the natural history of disease . RESULTS A total of 620 sequential patients were r and omized ( CNS n = 307 , control n = 313 ) , of which 361 were followed after discharge from hospital ( CNS n = 175 , control n = 186 ) . The groups were similar for the probability of in-hospital death ( CNS 9.3 % vs control 9.7 % ) or being discharged to the community ( 58.0 % vs 60.0 % ) . The groups did not differ for postdischarge outcomes including readmission or death ( 21.6 % vs 15.6 % ; P = 0.16 ) or risk of adverse event ( 23.6 % vs 22.8 % ) . Mean [ SD ] patient ratings of overall quality of care on a scale of 10 was higher in the clinical nurse specialist group ( 8.2 [ 2.2 ] vs 7.6 [ 2.4 ] ; P = 0.052 ) . CONCLUSION The addition of a clinical nurse specialist to a medical team improved patient satisfaction but did not impact hospital efficiency or patient safety Repeated hospitalizations result in high costs and may occur as a result of patient errors in their medication regimen . To reduce rehospitalizations ( hospitalizations within 31 days of the previous discharge ) , health care professionals have turned to the discharge planning process . Using Orem ' 
    Output:
    
No single intervention implemented alone was regularly associated with reduced risk for 30-day rehospitalization .