***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: CONTEXT Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients , but the benefits of more intensive follow-up of hospitalized elders at risk for poor outcomes after discharge has not been studied . OBJECTIVE To examine the effectiveness of an advanced practice nurse-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions .  DESIGN R and omized clinical trial with follow-up at 2 , 6 , 12 , and 24 weeks after index hospital discharge . SETTING Two urban , academically affiliated hospitals in Philadelphia , Pa. PARTICIPANTS Eligible patients were 65 years or older , hospitalized between August 1992 and March 1996 , and had 1 of several medical and surgical reasons for admission . INTERVENTION Intervention group patients received a comprehensive discharge planning and home follow-up protocol design ed specifically for elders at risk for poor outcomes after discharge and implemented by advanced practice nurses . MAIN OUTCOME MEASURES Readmissions , time to first readmission , acute care visits after discharge , costs , functional status , depression , and patient satisfaction . RESULTS A total of 363 patients ( 186 in the control group and 177 in the intervention group ) were enrolled in the study ; 70 % of intervention and 74 % of control subjects completed the trial . Mean age of sample was 75 years ; 50 % were men and 45 % were black . By week 24 after the index hospital discharge , control group patients were more likely than intervention group patients to be readmitted at least once ( 37.1 % vs 20.3 % ; P<.001 ) . Fewer intervention group patients had multiple readmissions ( 6.2 % vs 14.5 % ; P = .01 ) and the intervention group had fewer hospital days per patient ( 1.53 vs 4.09 days ; P<.001 ) . Time to first readmission was increased in the intervention group ( P<.001 ) . At 24 weeks after discharge , total Medicare reimbursements for health services were about $ 1.2 million in the control group vs about $ 0.6 million in the intervention group ( P<.001 ) . There were no significant group differences in post-discharge acute care visits , functional status , depression , or patient satisfaction . CONCLUSIONS An advanced practice nurse-centered discharge planning and home care intervention for at-risk hospitalized elders reduced readmissions , lengthened the time between discharge and readmission , and decreased the costs of providing health care . Thus , the intervention demonstrated great potential in promoting positive outcomes for hospitalized elders at high risk for rehospitalization while reducing costs This paper evaluates the Post-Hospital Support Program for the frail elderly and their caregivers using a quasi-experimental design . The program goals were to reduce stress in the caregivers , improve functioning and reduce mortality in patients , and reduce health service utilization in patients . Subjects were patients at the Johns Hopkins Hospital in Baltimore , Maryl and , age 65 or over , who were returning home to the care of a non-paid caregiver and who had extensive post-hospital care needs which were expected to continue for at least one year . The 93 comparison group patient/caregiver pairs were discharged between May 15 , 1983 and May 14 , 1984 . The 98 treatment group pairs were discharged between May 15 , 1984 and May 14 , 1985 . Interviews were conducted with patients and caregivers at 1 , 3 , 6 , 9 , and 12 months after discharge . Results showed a slight reduction in caregiver stress and a substantial reduction in hospital days used by the treatment group . When confounding and history effects are taken into consideration , an average difference of 6.5 days per patients remains . The data also suggest that the treatment program may have postponed some deaths and nursing home placements . The results suggest that support services for the frail elderly and their caregivers can be cost efficient by reducing hospital length-of-stay . Savings were estimated at $ 4,585 per patient per year in this study . However , further work is needed to design programs which more effectively reduce caregiver stress The PREP system of nursing interventions , design ed to increase preparedness ( PR ) , enrichment ( E ) , and predictability ( P ) in families providing care to older people , was pilot tested for acceptability and preliminary effectiveness . Eleven family units were assigned to the PREP group and 11 to a st and ard home health control group .  The PREP group scored approximately one SD higher than the control group ( p < .05 ) on the Care Effectiveness Scale , indicating greater preparedness , enrichment , and predictability . Further , on a rating of overall usefulness , the PREP group rated their assistance from PREP nurses ( M = 9.75 ) as significantly higher ( p < .01 ) than the control group rated assistance from the home health nurse or physical therapist ( M = 6.57 ) . Although not statistically significant , mean hospital costs for the PREP group ( $ 2,775 ) were lower than for the control group ( $ 6,929 ) . Results provided support for a full intervention trial BACKGROUND The benefit of multidimensional assessment and management of older people remains controversial . Most trials have been too small to produce adequate evidence to inform policy . We aim ed to measure the effects of different approaches to assessment and management of older people . METHODS We undertook a cluster-r and omised factorial trial in 106 general practice s ( 43219 eligible patients aged 75 years and older , 78 % participation ) , comparing ( 1 ) universal versus targeted assessment and ( 2 ) subsequent management by hospital outpatient geriatric team versus the primary -care team .  All participants received a brief multidimensional assessment followed by a nurse-led in-depth assessment in the universal group , whereas in the targeted group the in-depth assessment was offered only to those with problems established at the brief assessment . Referrals to the r and omised team ( geriatric management or primary care ) , other medical or social services , health-care workers , or agencies , and emergency referrals to the general practitioner were based on a st and ard protocol at the in-depth assessment . The primary endpoints were mortality , admissions to hospital and institution , and quality of life . Analysis was by intention to treat and per protocol . This trial has been assigned the International St and ardised R and omised Controlled Trial Number IS RCT N23494848 . FINDINGS Mortality and hospital or institutional admissions did not differ between groups . During 3 years ' follow-up , significant improvements in quality of life result ed from universal versus targeted assessment in terms of homecare , and from management by geriatric team versus primary -care team , in terms of mobility , social interaction , and morale . However , only the result for social interaction was consistent with a small but important effect . INTERPRETATION The different forms of multidimensional assessment offered almost no differences in patient outcome Health visitors were employed specifically to care for two years for a r and om sample of patients in general practice who were aged over 70 . Independent assessment s made at the beginning and end of the study showed that the health visitor in an urban practice had some impact on her caseload of patients ; she provided more services for them , their mortality was reduced , and their quality of life improved , though the last measure just failed to be statistically significant . The health visitor working in a rural practice had no such effect Background Preventive home visits to elderly people by public health nurses aim to maintain or improve the functional status of elderly and reduce the use of institutional care services . A number of trials that investigated the effects of home visits show positive results , but others do not . The outcomes can depend on differences in characteristics of the intervention programme , but also on the selection of the target population . A risk group approach seems promising , but further evidence is needed . We decided to carry out a study to investigate the effects in a population of elderly with ( perceived ) poor health rather than the general population . Also , we test whether nurses who are qualified at a lower professional level ( home nurses instead of public health nurses ) are able to obtain convincing effects . The results of this study will contribute to the discussion on effective public health strategies for the aged . Methods / design The study is carried out as a parallel group r and omised trial . To screen eligible participants , we sent a postal question  naire to 4901 elderly people ( 70–84 years ) living at home in a town in the south of the Netherl and s. After applying inclusion criteria ( e.g. , self-reported poor health status ) and exclusion criteria ( e.g. , those who already receive home nursing care ) , we selected 330 participants . They entered the r and omisation procedure ; 160 were allocated to the intervention group and 170 to the control group .  The intervention consists of ( at least ) 8 systematic home visits over an 18 months period . Experienced home nurses from the local home care organisation carry out the visits . The control group receives usual care .  Effects on health status are measured by means of postal question naires after 12 months , 18 months ( the end of the intervention period ) and after 24 months ( the end of 6-months follow-up ) , and face-to-face interviews after 18 months . Data on mortality and service use are continuously registered during 24 months . A cost-benefit analysis is included . The design and setting of the study , the selection of eligible participants and the study interventions are described in this article . Other included items are : the primary and secondary outcome measures , the statistical analysis and the economic evaluation Abstract Background The objective of this article is to describe the design of an evaluation of the cost-effectiveness of systematic home visits by nurses to frail elderly primary care patients . Pilot objectives were : 1 . To determine the feasibility of postal multidimensional frailty screening instruments ; 2 . to identify the need for home visits to elderly . Methods Main study : The main study concerns a r and omized controlled in primary care practice s ( PCP ) with 18 months follow-up and blinded PCPs . Frail persons aged 75 years or older and living at home but neither terminally ill nor demented from 33 PCPs were eligible . Trained community nurses ( 1 ) visit patients at home and assess the care needs with the Resident Assessment Instrument-Home Care , a multidimensional computerized geriatric assessment instrument , enabling direct identification of problem areas ; ( 2 ) determine the care priorities together with the patient ; ( 3 ) design and execute interventions according to protocol s ; ( 4 ) and visit patients at least five times during a year in order to execute and monitor the care-plan . Controls receive usual care . Outcome measures are Quality of life , and Quality Adjusted Life Years ; time to nursing home admission ; mortality ; hospital admissions ; health care utilization . Pilot 1 : Three brief postal multidimensional screening measures to identify frail health among elderly persons were tested on percentage complete item response ( selected after a literature search ): 1 ) Vulnerable Elders Screen , 2 ) Strawbridge 's frailty screen , and 3 ) COOP-WONCA charts . Pilot 2 : Three nurses visited elderly frail patients as identified by PCPs in a health center of 5400 patients and used an assessment protocol to identify psychosocial and medical problems . The needs and experiences of all participants were gathered by semi-structured interviews . Discussion The design holds several unique elements such as early identification of frail persons combined with case-management by nurses . From two pilots we learned that of three potential postal frailty measures , the COOP-WONCA charts were completed best by elderly and that preventive home visits by nurses were positively evaluated to have potential for quality of care improvement Over three years 285 r and omly selected subjects aged 75 years or more and living in a suburb of Copenhagen were visited every three months in their own homes ( the intervention group ) to assess whether scheduled medically and socially preventive intervention would influence the number of admissions to hospitals or nursing homes , the number of contacts with general practice , or mortality .  A r and omly selected group of 287 people of the same age and sex were visited during the final three months of the study ( the control group ) . Two hundred and nineteen admissions to hospitals ( 4884 bed days ) were registered for the intervention group compared with 271 ( 6442 bed days ) for the control group . Especially during the second half of the study , a significant reduction in the number of admissions to hospitals was seen in the intervention group . Twenty people in the intervention group and 29 in the control group moved into nursing homes ( p greater than 0.05 ) . The corresponding numbers of deaths were 56 and 75 ( p less than 0.05 ) . No difference was seen in the number of contacts with general practice . Significantly fewer emergency medical calls , however , were registered for the intervention group . Subjects in the intervention group benefited from the regular visits and the increased distribution of aids and modifications  to their homes to which these led . The regular visits probably also produced an important increase in confidence The aim of this prospect i ve , r and omized and controlled trial was to carry out and evaluate a model for follow-up by home visits after discharge from hospital of persons aged 75 years or more . The trial was a feasibility study in which hospital staff , district nurses , and general practitioners already working within the hospital and the primary health sector participated , with changes in the usual organization . On the day after their discharge from hospital , 163 patients were visited in their homes by the district nurse .  Two weeks later , they were evaluated at home by their general practitioner . For 181 control patients , discharge took place according to the usual procedures . Endpoints were evaluated one year after discharge . Significantly more patients from the control group had been admitted to nursing homes as compared with the trial group ( 25/10 , p < 0.05 ) ; the control patients stayed 2700 days at institutions , the trial group 1950 days . It is proposed that this simple and practicable follow-up routine be introduced in connection with discharge of elderly persons from hospital Abstract Objective : To evaluate whether a programme of multifactorial home visits reduces falls 
    Output:
    
Seven trials were of sufficient method ological quality ; none of the trials showed a significant favorable effect for the main analysis comparing the intervention group with the control group on mortality , health status , service use or cost .
The inclusion of less-intensive intervention programs for frail older persons would not have exerted a great influence on the findings of our review .
Conclusion We conclude that home visiting programs appear not to be beneficial for older people with poor health within the health care setting of Western countries