***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: 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 BACKGROUND Recent studies have suggested that there is a positive impact of patient-centered care ( PCC ) on both the patient-physician relationship and subsequent patient health-related behaviors . One recent prospect i ve study reported a significant relationship between the degree of PCC experienced by patients during their hospitalization for acute myocardial infa rct ion ( AMI ) and their postdischarge cardiac symptoms . A limitation of this study , however , was a lack of information regarding the technical quality of the AMI care , which might have explained at least part of the differences in outcomes . The present study was undertaken to test the influence of both PCC and technical care quality on outcomes among AMI patients . METHODS We analyzed data from a national sample of 1,858 veterans hospitalized for an initial AMI in a Department of Veterans Affairs medical center during fiscal years 2003 and 2004 for whom data had been compiled on evidence -based treatment and who had also completed a Picker question naire assessing perceptions of PCC .  Cox proportional hazards models were used to estimate the relationship between  PCC  and survival 1-year postdischarge , controlling for technical quality of care , patient clinical condition and history , admission process characteristics , and patient sociodemographic characteristics . We hypothesized that better PCC would be associated with a lower probability of death 1-year postdischarge , even after controlling for patient characteristics and the technical quality of care . RESULTS Better PCC was associated with a significantly but modestly lower hazard of death over the 1-year study period ( hazard ratio 0.992 , 95 percent confidence interval 0.986 - 0.999 ) . CONCLUSIONS Providing PCC may result in important clinical benefits , in addition to meeting patient needs and expectations Progress towards the Millennium Development Goals ( MDGs ) has been uneven . Inequalities in child health are large and effective interventions rarely reach the most in need . Little is known about how to reduce these inequalities . We describe and explain the equity impact of a  women ’s group intervention in India that strongly reduced the neonatal mortality rate ( NMR )  in a cluster-r and omised trial . We conducted secondary analyses of the trial data , obtained through prospect i ve surveillance of a population of 228 186 . The intervention effects were estimated separately , through r and om effects logistic regression , for the most and less socio-economically marginalised groups . Among the most marginalised , the NMR was 59 % lower in intervention than in control clusters in years 2 and 3 ( 70 % , year 3 ) ; among the less marginalised , the NMR was 36 % lower ( 35 % , year 3 ) . The intervention effect was stronger among the most than among the less marginalised ( P-value for difference = 0.028 , years 2 - 3 ; P-value for difference = 0.009 , year 3 ) . The stronger effect was concentrated in winter , particularly for early NMR . There was no effect on the use of health-care services in either group , and improvements in home care were comparable . Participatory community interventions can substantially reduce socio-economic inequalities in neonatal mortality and contribute to an equitable achievement of the unfinished MDG agenda BACKGROUND Community mobilisation through participatory women 's groups might improve birth outcomes in poor rural communities . We therefore assessed this approach in a largely tribal and rural population in three districts in eastern India . METHODS From 36 clusters in Jharkh and and Orissa , with an estimated population of 228 186 , we assigned 18 clusters to intervention or control using stratified r and omisation . Women were eligible to participate if they were aged 15 - 49 years , residing in the project area , and had given birth during the study . In intervention clusters , a facilitator convened 13 groups every month to support participatory action and learning for women , and facilitated the development and implementation of strategies to address maternal and newborn health problems . The primary outcomes were reductions in neonatal mortality rate ( NMR ) and maternal depression scores . Analysis was by intention to treat . This trial is registered as an International St and ard R and omised Controlled Trial , number IS RCT N21817853 . FINDINGS After baseline surveillance of 4692 births , we monitored outcomes for 19 030 births during 3 years ( 2005 - 08 ) . NMRs per 1000 were 55.6 , 37.1 , and 36.3 during the first , second , and third years , respectively , in intervention clusters , and 53.4 , 59.6 , and 64.3 , respectively , in control clusters . NMR was 32 % lower in intervention clusters adjusted for clustering , stratification , and baseline differences ( odds ratio 0.68 , 95 % CI 0.59 - 0.78 ) during the 3 years , and 45 % lower in years 2 and 3 ( 0.55 , 0.46 - 0.66 ) . Although we did not note a significant effect on maternal depression overall , reduction in moderate depression was 57 % in year 3 ( 0.43 , 0.23 - 0.80 ) . INTERPRETATION This intervention could be used with or as a potential alternative to health-worker-led interventions , and presents new opportunities for policy makers to improve maternal and newborn health outcomes in poor population s. FUNDING Health Foundation , UK Department for International Development , Wellcome Trust , and the Big Lottery Fund ( UK ) Objective The objective of this study was to describe the involvement of patients or their representatives in quality management ( QM ) functions  and to assess associations between levels of involvement and the implementation of patient-centred care strategies . Design A cross-sectional , multilevel study design that surveyed quality managers and department heads and data from an organizational audit . Setting R and omly selected hospitals ( n = 74 ) from seven European countries ( The Czech Republic , France , Germany , Pol and , Portugal , Spain and Turkey ) . Participants Hospital quality managers ( n = 74 ) and heads of clinical departments ( n = 262 ) in charge of four patient pathways ( acute myocardial infa rct ion , stroke , hip fracture and deliveries ) participated in the data collection between May 2011 and February 2012 . Main Outcome Measures Four items reflecting essential patient-centred care strategies based on an on-site hospital visit : ( 1 )  formal survey seeking views of patients and carers , ( 2 ) written policies on patients ' rights , ( 3 ) patient information literature including guidelines and ( 4  ) fact sheets for post-discharge care .  The main predictors were patient involvement in QM  at the ( i ) hospital level and ( ii ) pathway level . Results Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level ( mean score 1.6 on a scale of 0 to 5 , SD 0.7 ) , but even lower at departmental level ( mean 0.6 , SD 0.7 ) . We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies ; however , the smallest hospitals were more likely to have implemented patient-centred care strategies . Conclusions There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care ; however , lack of evidence should not be interpreted as evidence of no effect BACKGROUND We design ed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization . METHODS We selected 39 family physicians at r and om , and 315 of their patients participated . Office visits were audiotaped and scored for patient-centered communication . In addition , patients were asked for their perceptions of the patient-centeredness of the visit . The outcomes were : ( 1 ) patients ' health , assessed by a visual analogue scale on symptom discomfort and concern ; ( 2 ) self-report of health , using the Medical Outcomes Study Short Form-36 ; and ( 3 ) medical care utilization variables of diagnostic tests , referrals , and visits to the family physician , assessed by chart review . The 2 measures of patient-centeredness were correlated with the outcomes of visits , adjusting for the clustering of patients by physician and controlling for confounding variables . RESULTS Patient-centered communication was correlated with the patients ' perceptions of finding common ground . In addition , positive perceptions ( both the total score and the subscore on finding common ground ) were associated with better recovery from their discomfort and concern , better emotional health 2 months later , and fewer diagnostic tests and referrals . CONCLUSIONS Patient-centered communication influences patients ' health through perceptions that their visit was patient centered , and especially through perceptions that common ground was achieved with the physician . Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals PURPOSE / OBJECTIVES To describe community-based participatory processes used to develop  promotore  training on cancer research , and to assess the feasibility of training promotores from rural communities to disseminate cancer research information . DESIGN Prospect i ve , cohort design . SETTING Rural communities in the state of Kansas . SAMPLE 34 Spanish-speaking promotores attended an information session ; 27 enrolled and 22 completed training . METHODS With input from a community advisory board , the authors developed a leadership and cancer curriculum and trained Spanish-speaking promotores to disseminate information on cancer research . Promotores completed pretraining and post-training surveys in Spanish to assess demographic characteristics and changes in knowledge of cancer , cancer treatment and cancer research studies , and intent to participate in cancer research . MAIN RESEARCH VARIABLES Cancer knowledge , awareness of cancer clinical trials , interest in participating in cancer clinical research studies . FINDINGS Compared to pretraining , after training , promotores were more likely to correctly define cancer , identify biopsies , describe cancer stages , and report ever having heard of cancer research studies . CONCLUSIONS Completion rates of the training and willingness to participate in cancer research were high , supporting the feasibility of training promotores to deliver community-based education to promote cancer research participation . IMPLICATION S FOR NURSING Nursing professionals and research ers can collaborate with promotores to disseminate cancer education and research among underserved rural Latino communities in Kansas and elsewhere . Members of these communities appear willing and interested in improving their knowledge of cancer and cancer clinical trials Purpose : This article uses an interactional analysis instrument to characterize patient-centered care in the primary care setting and to examine its relationship with health care utilization . Methods : Five hundred nine new adult patients were r and omized to care by family physicians and general internists . An adaption of the Davis Observation Code was used to measure a patient-centered practice style . The main outcome measures were their use of medical services and related charges monitored over 1 year . Results : Controlling for patient sex , age , education , income , self-reported health status , and health risk behaviors ( obesity , alcohol abuse , and smoking ) , a higher average amount of patient-centered care recorded in visits throughout the 1-year study period was related to a significantly decreased annual number of visits for specialty care ( P = .0209 ) , less frequent hospitalizations ( P = .0033 ) , and fewer laboratory and diagnostic tests ( P = .0027 ) . Total medical charges for the 1-year study were also significantly reduced ( P = .0002 ) , as were charges for specialty care clinic visits ( P = .0005 ) , for all patients who had a greater average amount of patient-centered visits during that same time period . For female patients , the regression equation predicted 15.47 % of the variation in total annual medical charges compared with male patients , for whom 31.18 % of the variation was explained by the average percent of patient-centered care , controlling for sociodemographic variables , health status , and health risk behaviors . Conclusions : Patient-centered care was associated with decreased utilization of health care services and lower total annual charges . Reduced annual medical care charges may be an important outcome of medical visits that are patient-centered Background Patients are increasingly seen as active partners in healthcare . While patient involvement in individual clinical decisions has been extensively studied , no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population . The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level . Methods Design : Cluster r and omized controlled trial . Local communities were r and omized in intervention ( priority setting with patient involvement ) and control sites ( no patient involvement ) . Setting : Communities in a canadian region were required to set priorities for improving chronic disease management in primary care , from a list of 37 vali date d quality indicators . Intervention : Patients were consulted in writing , before participating in face-to-face deliberation with professionals . Control : Professionals established priorities among themselves , without patient involvement . Participants : A total of 172 individuals from six communities participated in the study , including 83 chronic disease patients , and 89 health professionals . Outcomes : The primary outcome was the level of agreement between patients ’ and professionals ’ priorities . Secondary outcomes included professionals ’ intention to use the selected quality indicators , and the costs of patient involvement . Results Priorities established with patients were more aligned with core generic components of the Medical Home and Chronic Care Model , including : access to primary care , self-care support , patient participation in clinical decisions , and partnership with community organizations ( p < 0.01 ) . Priorities established by professionals alone placed more emphasis on the technical quality of single disease management . The involvement intervention fostered mutual influence between patients and professionals , which result ed in a 41 % increase in agreement on common priorities ( 95%CI : + 12 % to 
    Output:
    
Studies engaged patients at multiple levels of the health care system and suggested that in-person deliberation with health system leadership was most effective .
Studies involving patient engagement in research focused on increasing study participation .
Discussion PFACs engage communities through individual projects but evidence of their impact on outcomes is lacking .